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I NAMF/AUDI lwhide NATIr)tIAI I—II III ANINI`,, I LIIN)IIIAr1/1NSY'.IIM(\/'/)IS1 Form V <br /> Locanonifdil1 - DISCHARGE MON. 'ING REPORT r11t110 OMB No. 40-0004 <br /> iLU -"tNLLLaLNT_LLLkL--L_-Gunk LU- _--- -- -- -- -____--(216f_ ___ -___-- --f!7-1 f-- F - FINAL Approval expires 9-30-85 <br /> •,l x I;,%L------------- ()(]U3��_ SECT 11 <Ur2=10YR24hR <br /> 7 ARFi J iNU.,t - ------�� 3 PERMIT NUMBER DISCHARGE NUM DER <br /> --- <br /> -------------- MONITORING PERIOD <br /> ----------------- YEAR MO DAY YEAR MO DAY <br /> N FROM TO L M I NOR <br /> DIANA AS i3r," RI] (20-21) 122-23) (24-25) (26.27) (28-29) /30-31/ NOTE: Read instructions before completing this form. <br /> (3 Card Oniv) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION No. FREQUENCY SAMPLE <br /> PARAMETER (46-53) (54.61) (38-45) (46-53) (54-61) or <br /> (32-371 >< EX ANALYSIS TYPE <br /> L AVERAGE MAXIMUM UNITS MINIMUM AVE�R,.yAL.GGE MAXIM,Uy,M� UNITS 62.63 (64-68) (69-70) <br /> SD Lk LASk SAMPLE — ** **;a 4c** <br /> L MEASUREMENT —— — (��-- <br /> 1 0 PERMIT R EPURT #* ** Es=1 NEEKLYYISUAL <br /> ENT GROSS VHil <br /> REQUIREMENT DAILY MX = *** <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> LE PRINCIPAL EXECUTIVE OFFICER 1 171KNTIFY UNDLR PENALTY ..F LAW THAT I HAVE PERSONALLY LXAMINKO TELEPHONE D A T E <br /> O A M LIA M r IR WITH THG INFORMATION SUDMITTCO HERLIN ANO BA/LD <br /> �/• r ON MY INA UIRY OF <br /> T1109F INDIVIDVALS IMMEDIATELY wLaPONl19 LE FOR <br /> 1/ /� 1/ OBTAINING TML INFORMATION, 1 BELIL VC THE SUBMITTED INFORMATION /'�^ <br /> / a Y ! I! rRUP, ACCU`RA TE ANORCOM IL ETE I AAM AWARE THAT THLRL ARL !IG- <br /> NIr IC ANT rE O I LS! INPOI MATION, INCLUDING — O <br /> THe ro sslelurr of 'IN. <br /> AND IMrRIs„NMEnr. Sec u.s c. 4 IaUI ^ SIGNAI URE OF PRINCIPAL EX CUTIVE '`7)LL/J\�,/oy�• <br /> 7— as U.a.C. 4 I an. IPenafnes under th+sr statures may include fines up to 310,000 <br /> TYPED OR PRIM ED arrd,nr ma1/nnun unpnsonnlcgt ofhct)1•,-rn 6+nonths and 5 years) OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY .1 <br /> AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> DISCHARGE OCCURS RPT NU DI �CHKGtt' UN YOUR DMK . <br /> 3320-1 (RPv. 10-79) PREVIOUS EDITION FO BC USED IItLPLACES EPA FORM T-40 WHILJI MAY NOr UL IJ C17 I /�/n� may( ( (' )-y PAGE OF <br /> UNTIL SUPPLY IS EXHAUST ED. 005 /b/UU;--bVb-152 ( 2 R <br />