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NATIONAL POLLUTAH'i JASCHARGE ELIMINATION SYSTEM - <br /> DISCHARG' JITORING REPORT rm NO. JM- <br /> fB NO. Sd-lt00T3 <br /> r 4,D-CT C Al- (PREP PL4NT <br /> 'O �30X Ih8 <br /> CAIt6,)O)ALE INSTRUCTIONS <br /> + L CO 81623 1. Provide dales for period covered by this report in spaces marked"REPORTING PERIOD". <br /> Y. Enter reported minimum, overage and maximum values under"QUANTITY"and"CONCENTRATION" <br /> 10-141 (17.191 In the units specified fur each parameter as appropriate. Do not enter values In boxes containing <br /> eater <br /> !sk& "AVERAGE" is average computed over actual time discharge is operating. "MAXIMUM" <br /> 11 and"MINIMUM" are extreme values observed during the reporting period. <br /> f 0UG0396 !'i'? 1211 3. Specify the number of analyzed samples that exceed the maximum(and/or minimum as appropriate) <br /> ST PERMIT NUMBER DIS fIC LATITUDE LONGITUDE permit conditions in the columns labeled"No. Ex." If none,enter"O". <br /> 4. Specify frequency of analysis for each parameter**No. analyses/No. days. (e.g., "3/7" is squiva- <br /> tzo•zu uz•xa to-zel ue•m Ia-zsl too-au tent to 3 analyses performed every 7 days) If continuous enter"CONT." <br /> S• Specify sample type("drab"or"_hr. composite")as applicable. If frequency was continuous, <br /> enter "NA". <br /> REPORTING PERIOD; FROM 119 1 ' 4 I TO YE Wfl7 1 8. Appropriate signature is required on bottom of this form.AR MO DAY OAY 7. Remove carbon and retain copy for your reconde. <br /> 8. Fold along dotted lines, staple and mail Original to office specified In pensit. <br /> 1 sa•sli _ 104-e0 tee-Tm <br /> (3 card only) QUANTITY (e card only) CONCENTRATION FREQUENCY <br /> PARAMETER tie-am t.e-esl Iehe ml 102-sa 1aa-410 — 100-asl 1e4-ell__ —_ tez•e3 OF SAMPLE <br /> MINIMUM AVERAGE MAXIMUM UNI7f EX MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> FLO.'! IN CONGUIT RHPogT►D iF M N # # # 17 II # IS Y # <br /> h PLgMIT MGD --- - MGD <br /> CONDITION # * IS # IS # # # # tt # # tt fI # ti IS # # # # # # u 7/7 IN <br /> I r 0 REPORTED C,- * fy k i► # # # p # <br /> L I :Sr TOT L DIS5 <br /> (OISS iLVEM PERMIT EKG/DAY — MG/L <br /> 7 ,3•IU CONDITION In # # * R p # ii # # IIIIS !/ # # # # # # # 1F <br /> i/7 GR <br /> 5'`'L(I-f,rSa T3TAL SUSP REPORTED {} IS M # N # # # <br /> PERMIT ..� MG/L r� <br /> CONDITION '"-N fI IF 1i # # # 30 1/7 li0 <br /> i�0^I�T0T4L(AS FEE} REPOR7H0 # # # # # # IS IS <br />' PERMIT -- M6/1-1 — <br /> )G4S CONDITION +► # �► IS # R q # # # I 5 7a 1/7 CO <br /> P H 9 I LD REPORTED y1 # * # # 0 IS f1 U <br /> C � <br /> PERMIT J -SI�__ - <br /> ii4;t) CONDITION IS +► +► +► li * +► # 6a0 +► i< # # &9. 1/7 GR <br /> ('+IL 6 GP,EASF9 VISUAL REPORTED # p # # # # n # a IS <br /> PERMIT 10 —• I 1/7 VI <br /> A J',,2 CONOI TiON # # # # Y # M # # {} ly * # # # 4 # <br /> REPORTED <br /> PERMIT <br /> CONDITION <br /> REPORTED <br /> PERMIT <br /> CONDITION <br /> NAME OF PRINCIPAL EXECUTIVE OFFICER TITLE OF THE OFFICER DATE <br /> (certify that f am familiar with the Information contained In this <br /> RECI-0 10 iy, 1 11. PIP aC`'��' ! a � report and that to the beat of my knowledge and belief such Infor <br /> 1� J V fl AJ �1 _ PIP ration Is true, complete, and accurate. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> LAST FIRST MI TITLE YEAR MO OAY OFFICER OR AUTHORIZED AGENT <br /> EPA Faun 3320.1(10.14 PAGE OF <br /> WOOD YV}f Al� -�.3 ORIGINAL 1 1 <br /> 0115 I5 +RE*T-F48-• -k, F#26M-E@Ti�-PkE�izFt�C�N`Pt` <br /> -Ahf- ANY SIwGLE`GRAB CANNOT EXCEED 45 /MG/L FOR TSS <br />