Laserfiche WebLink
NATIONAL POLI UTAN HARGE ELIMINATION SYSTEM <br /> DISCHARGE MuNITORING REPORT Form Approved <br /> oms NO. 1SS-ROO13 <br /> r A10 —Cr Col--L PLAkT <br /> Po Ba,r /5'a <br /> CAR&A) DALE <br /> GO 814 2 3 INSTRUCTIONS <br /> 1. Provide dabs for perlud covarad Ly We report in spaces marked"REPORTING PERIOD". <br /> 1. Enter reported mieimtlrn,average and maximum values under"QUANTITY"and"CONCENTRATION" <br /> It R u 1m 17 1s) in the units specified for each parameter as appropriate. Do not enter values lu Lcxua containing <br /> ------- --- asterisks. "AVERAGE" Is everaae computed over actual time discharge is operating, "MAXIMUM" <br /> and"MINIMUM"are extreme values observed during the repelling period. <br /> ]j7 <br /> 3 y � 3. Specify the number of analysed ermples'hat erceed the maximum(and/or minimise as appropriate) <br /> PERMIT NUMBER DIS sic LATITUOE LONGITUDE rt•-lnit conditions in the columns labeled"No Ex." It cone,enter I40". <br /> _ 4. Sperify frequency of analysis for each parameter ae No analyses/No. days. (e Q., rr3/7"Is equtva- <br /> Ita•tu Itt-tel lariat Ire 271 (ao•to) Ise-au lent to,i aualysea Performed every 7 days 1 It continl.ouo toter"CONT." <br /> S. Specify sample type("grab"or hr. composite")as applicable. If frequency was continuous, <br /> -•') 7 enter NA"• <br /> r Ri:PORTING PERIOD PROM /p d l! f TO 71? d �J I 6. App ropnate signature is required on bottom c•t this form. <br /> EAR MID.- -O AY YEAR —MO DAV 7. Remove celbon end-fain copy for your recolde. <br /> S. Fold along dotted lines, staple and msil Original to office specified to permit. <br /> 1 a]•9r1 le+-sal (ea-rat <br /> (3 cap only) (I card unlr'1 <br /> QUANTITY CONCENTRATION PREUUFNGr <br /> lee-+al IM-ea fa4e ll labea'lee-+a1 l+e•eal 1eae0 tat-el SAMPLE <br /> PARAMETER _ `— _____..-____ _ -- _ OF <br /> NO <br /> MINIMUM AVERAGE MAXIMUM UNITS CrOI• MINIMUM AVERAGE MAXIMUM IINIIi EX ANALYSIS TYPE <br /> RaPORTaD <br /> P aRMIT — — <br /> (.ONOITION <br /> RfiPONrao <br /> co"01 r1ON <br /> REP OR7fiU <br /> PERMIT <br /> CONOI TIDN �.?.._ <br /> • REPORTED_ <br /> PERMIT <br /> CONDITION <br /> REPDRTEO 1 <br /> PERMIT 1 t <br /> CONOI TI ON <br /> HLPORTEO <br /> CONDI TION <br /> REPORT ED <br /> -- <br /> CONDITION <br /> HEPn RTEn <br /> C.Noll W. <br /> NAME OF PRINCIPAL EXECUTIVE OFFICER TITLE OF Tt/E OFFICER DATe __... <br /> ------ --------- --'----"'--------'-'-------- I certify that f am femlllar with the Information contained In We —� <br /> ^� report and that hl the best of my knowledao and belief such infor- s.L.� -Sc` ^!j•_,,.-. <br /> _-PIE& �V� --_� � _____ -_____ .EX.fCt- f __����, _�!_ %W _ oration Ia true, complete,and accurate 41rhATui.0 OF PRINCIPAL EXECUTIVE <br /> LAST FIRST MI TITLE YEAR MO OAV OFFICER OR AUTHORIZED AGENT <br /> gPA form 3120•I 110.7?)_--� PAGE OF _— <br /> ORIGINAL <br />