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', i +r•, .I L.,j L ' jI..I_c_ 1 IIr 1 <br /> NAME _ _ y dry yy (17-19) <br /> ires2 2984 <br /> A DDRE86� Xxxx_ XXXXXXXX-XXXXX�/((X(X XNAXXXXXM___ r, - Id 13 I• <br /> -------- PERMIT NUMBER DI{CHARGE NUMBER <br /> _---AXXXXX%H_Q 0 S_YaleLFlagstaff,_ AZ <br /> 86001 MONITORING PERIOD <br /> F�C,CILITY��1,A��J ---I—,,1—,�______ YEAR MO DAY YEAR MO DAY <br /> LOCATION I•!Qntro Se_.CIItLII t,�C�411111 C1�d�_______ FROM .,j TO <br /> (20-21) (22.23) (21-23) ( 6 ) (28.29) (3a-3 ) NOTE: Read instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (I Curd Only) QUALITY OR CONCENTRATION <br /> PARAM[TLA (46-33) (5I-61) (38-I5) (46-5I) (3I-61) NO. FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> (32.17) >< AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITE 62-63) (61.68) (69-70) <br /> SAMPLE <br /> ` I IN ) MEASUREMENT 0.038 0. 106 <br /> PERMIT G'', <br /> REQUIREMENT <br /> 51i ,5 * 4 w t7 :� t ,t + * * ,t _ +v * >i t # * * 1 /3 } C T <br /> SAMPLE <br /> SQLI'3 , TGT ''L MEASUREMENT X t * t * k M 4.00 i 4.00 4.00 <br /> (EFFL0E.,,T) PERMIT RA <br /> �, REQUIREMENT �, �, * ,*, * * +, * * �, * k <br /> ,,531. 35 7;1 1 /30 GR <br /> SAMPLE <br /> I1�0i••! TOTAL MEASUREMENT 0.04 0.045 0.05 0 1/30 GRAB <br /> PERMITL <br /> I�1 11 N rJ REQUIREMENT * 7 :k * ftt �r * >IT .'I: 3.5 7•o J f 3 r P <br /> SAMPLE <br /> P.4,F IEL0 MEASUREMENT * ,4 y y * * * * * * * RA <br /> 1 PERMIT 91J <br /> V �1 J LI li REQUIREMENT ¢ �{ '} 6.5 * * * '#' 94.0 1/J Q G k <br /> SAMPLE <br /> OIL <br /> MEASUREMENT 0 1 30 VISUAL <br /> VISUAL PERM IT �•:1i/L f <br /> A 0 r fi REQUIREMENT �. ?k .dti Tk "* V T <br /> SAMPLE <br /> CO 1DUCTI1'ITY G/ MEASUREMENT * * * t 708 1298 1888 1 30 GRAB <br /> TCS (EFFLl3E''IT PERMIT <br /> 7 J 4 U I) REQUIREMENT Or GP <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> .................... 1-- 7 <br /> NAME/TITLE PRINCIPAL, EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED <br /> ON 1 .,�(I/�/�^ . TELEPHONE D A T E <br /> O AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> H. Theodore Smith OBTAINING THE INFORMATION 1 BELIEVE THE SUBMItTED INFORMATION <br /> IS TRUE ACCURATE AND COMPLETE 1 AM AWARE THAT TNERE ARE SIG <br /> Hydrologist NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SEE IB USC 1 1001 AND SIGNATURE OF PRINCIPAL EXECUTIVE 602 774-5253 86 07 24 <br /> l3USC 11319 lYeaollle. u.Ider these nalulr. Me I.Flud, /Inn up bI ItII IXXI <br /> TYPED OR PRINTED e.d'ur r.Ianmum unpnunlmenl o/h,wu 6 month.and t,wr,I OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> CODE <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Re/erence all uttaa/lmentr here) <br /> IF jN0 CISC►'tiRGE G T�fI:3 I••�_'w.=l•!TI P ,<If L, REPCRT IIvO DISCHARGE11 <br /> ' 1 1 <br /> EPA Form 3320-1 R@V. IO'79JPREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br /> UNTIL SUPPLY IS EXHAUSTED <br />