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NATIONAL POLLUTANT DISCHAPGE ELIMIN,TION S+'brCM
<br /> DISCHARC ITORING REPORT
<br />_t I--
<br /> _rT W! N PLP,Il(
<br /> INSTRUCTIONS
<br /> I ;i 1 f,,3 1. Provide dales for period covered by this report in spar c,v,..' 'I ' '(W I I;:,;111,110f)"
<br /> `-- - 2. Enter reported minimum, overage and maximum values sod,I �,I"(r.L, I
<br /> tw-Im 117 rot in the Units specified for each purnmeter as .µ,pi o,m.,U• 1- , i , ,I'I I-1, NI I.
<br /> -_.__ asterisks. "AVERAGE" is uverage con,puled over a,nlal tl
<br /> 12I and"MINIMUM" are extrmne values observed dwmj,Ilm
<br /> " �n 3`) ) 1; 3. Specify the number of analyzed samples that ex,-A ll.c m •. .r I,uumum at u){ r „I
<br /> S7 PERMIT NUMOER DIS SIC LATITUDE LONGITUDE Permit conditions in the columns labeled"Nu. Ex." Ii ti,-
<br /> ..,r
<br />�- -_- --�_--.-----__.-_-_-- _---__ - _ —. __--- 4. Specify frequency of analysis for corh purametei n5 No. en„ ,I,s (c g. "{'7" r•
<br /> 12a.2N 42:2N 12a-3e/ 110-271 12!•2v1 130-aU lent to 3 analyses perlomied every 7.lays) It t-it....a -
<br /> __ S. Specify sample type("grab"or"__-In. romposuc").r,: .µ�,.lI ��.I. II frequr"•-y I-.,<r, 1-1.W.,
<br /> 1 enter 'NA".
<br /> REPORTING PERIOD FROM t'1 70 I 6. Appropriate signature is required on bottom of this form.
<br /> YEAR -MO DAY YEAR MO _ OAY 7• Remove carbon and retain copy for your recottk
<br /> -- ---- -- - 8. Fold along dotted lines, staple and mall Ungui..l to ofN,a •p, r. I to p,•Iru 1.
<br /> - d not) I�a•eQUANTITV les-eu 1e2n31l4 CTI y) —_use N ----ia.-eu -_--_ ------ -- - - - - CY •- ---i
<br /> (3 card oalY) Ieard oM CONCENTRATION FI,L,ueNrY I '
<br /> PARAMETLN —_ -__.�. -_-- ,i 1)F Sri• v,i
<br /> I I MINIMUM AVERAGE MAXIMUM UNI15 N0 MINIMUM AVERAGE MAXIMUM UNITS T(PE
<br /> 1 •------.--_.-.--.—_-..__... -EX-- I I r I A N A 1-Y.1 S
<br /> "iL)•(T REPO HI aD it # # K # # # # # :t It I'
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<br /> ( 7 I i ,) — - -- --- ---- -- K G/DAY ---- --------- --------- ------- -- %./1_ ,
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<br /> PERMIT
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<br /> +. REP OHT ED 4 P # # # # # 4 fi # #_i'•.:.f T (, L k ' # {} to- a # k # J
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<br />✓ (1' f j O( 6 (yam� F. ) REPORTED p w 4 Y # # # >W # ifs {f /# if � it '
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<br /> r I �-------- _---CONDI T1ON - -- # # @ R +• # # -� {: # it I --'2•IJ ----- 7�----- - / ! I --
<br /> •. f -(--1 REPORTED A # >rt ;► p # N # # it # # It # i}
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<br /> -' -- -- —x M IfTL It It R It SL # # -- # # # -# ti#- ---/------- f -
<br /> CONOiliON
<br /> -------------- - --
<br /> REPORTED
<br /> PErIMIT
<br /> v I CON UI 7,ON
<br /> HEPORTEp I '
<br /> v PERMIT
<br /> C ONDI TION
<br /> NAME OF PRINCIPAL EXECUTIVE OFFICER TITLE OF THE OFFICER DATE -
<br />_ -----------'--------`--'- ----"_--- ----'-'--' - -- I cartlfy that f am famfllar with the fn/onnaflon contained in tldv .(;;(;1;,, + ✓.>, ^.,-,�:<: , ,
<br /> x/CdAl A NZ55 ,Wtv I SII� O � � sport and that to the heat of my knowledge and Woof such rnfor- -- :.v I•
<br /> __1-�,�,_�__� motion to true, comploto, and accurate. SIATI) t OF PFi VU 1PAi. T)t.'111 [_
<br /> `--- ON A------- ---- -- - ----- r-c t; u el,Ar,l rn;.:r.tz r,LA I FIRST MI TITLE YEAR MO DAY nFFl
<br />.. EPA Form 33I0.1()0-72) PAGE ul
<br /> ORIGINAL I ;
<br /> % I ' '-TTLFi) �,f -1F +14TE.R Fk01.1 N_FAR CRFFK MINE ANY `:f,VGI_E (yFAd CA)dN(1T
<br />` ;:XI L 5 '16/L F TS`3
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