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_ NATIONAL POLLUTA.4 1ARGE ELIMINATION SYSTEM <br /> 4 DISCHARGE MUNITORING REPORT .n Approved <br /> burr NO. Ise-ROO73 <br /> r L 619:V / MW.C_ ' s <br /> Po BoX $g <br /> CAR 8a� L� INSTRUCTIONS <br /> CV 1. Provide dates far period a.ovarsd b,thin report in spaces worked"REPORTING PERIOD". <br /> 1. Enter reported minimum, average and maximum values under "QUANTITY"a..d"CONCENTRATION" <br /> li•31 a-lu UT•Isl in the units specified for ouch parameter as approptime. Go not enter values In boxes containing <br /> - ---------------� -- -- - asterisks o.�, Specify frequency of enalytlltl for each parameter as. "AVERAGE" is average computed over actual Ume discharge is operating. "MAXIMUM" <br /> and"MINIMUM"are extreme values observed during the reporting pcnod. <br /> LQ LIOZ?>7�� I7)r 1Sprcify the number of analyzed samples that exceed the maximum(end/or minlmran as appropriate) <br /> - - ---------- - - - permit conditions in the columns labeled"Nu. Ex." if nurse, enter'O". <br /> 4T� PERMIT NUMBER DIS SIC LATITUDE-- _ LONGITUDE _ N analyses/No days. (e.g., "3/7"is equlva- <br /> tm-tu Aix-ia tzi•zm liar ue-xal I3a-au lent to J analyses perfomled every 7 days) If continuous enter"CONT." <br /> S. Spe..rfy sample type I"grab"or'r--hr. composite")as applicable. If frequency was continuous, <br /> enter "NA". <br /> REPORTING PERIOD: FROM 7 171III{b�j_ (5f 1 TO E o OLD 6. trtl•ro,li etc aigrl store/s r::qu ircd on bottom of this fort. <br /> YEAH I_MO .DAY YEAR MO DAY 7• Remove cartx,n and retain copy I`-youi records. <br /> 8• Fuld along dotted tine%, staplem end ail Orlgmal to office specified in permit. <br /> _ 422-_371 to+-au to—ol <br /> (3-donly) QUANTITY (4` da"y)—T~ CONCENTRATION — !— FREQUENCY <br /> i3a-<91 (4,e-e31 le+ell lai_a (W.W 14t-a31 to+all toi o3 [AMPLE <br /> PARAMETER --- -_ -- ___-- -._.._ _ _ _. -_--_ NO OF <br /> MINIMUM` AVERAGE MAXIMUM UNITS NO EX MINIMUM AVERAGE MAXIMUM y UNITS EX ANALYSIS TYPt <br /> REPO Too <br /> PERMI r — <br /> CONOITION <br /> REPORTED <br /> CO NO1110N <br /> REPORTED <br /> PE VON VI.T ION 7i— ___.� — __ ._.— — ._-_•-•___ _..�_--_ __—__� _ _�_—�— <br /> 1 <br /> • REPORTED ` <br /> PER MI r <br /> —� CONOI TIOII <br /> PERMIT \VVJ <br /> CONDI T.O. <br /> PERMIT -- <br /> 10WO1TION <br /> REPOFT SD <br /> PERMIT -- -_ — -- --- <br /> - - ----_— CONDITION <br /> NEPORTEO <br /> —. ._. PERMIT <br /> CONDITION <br /> NAME OF PRINCIPAL EXECUTIVE OFFICER TITLE OF THE uFFICER DATE �'/^l <br /> ------- -------------- ------- ---- f ceraly that I so familiar with the information contained In this 41-[�(.! Lrt<tit _i <br /> 11II J } . / 1�� :- L report end that to the best of my knowledge and belief auch infor- 1 V <br /> -/n1/N ��; �f �j��.0_Ez��-[. �(L}c AT fz_ l _�4-Y <br /> mutiorl la true, complete,and accurate. SIGNAT NE OF AUTHORIZED <br /> EXECUTIVE <br /> TIVE <br /> LAST FIRST Mf T, LE YEI.R MO D OFFICER OR AUTHORIZED AGENT <br /> EPA Form 3320•1110-72) PAGE OF <br /> ORIGINAL <br />