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N A I IONAL. P.LLUI ArIf I,"I.,IAHGI_ El_IMI NA I ION SYOTF.M
<br /> DISCHARGE 'TORING REPORT
<br /> i rA
<br /> 00 I;AI c
<br /> INS'f1tUCTIQNS
<br /> _v ,I 16",3 re
<br /> � 1. Provide dates for period covered by this port in spa rs, n,ml• d "PI-POPTING 1'I 10011".
<br /> 2. Enter reported minimum, average and maximum, v•d nr•, I,n Ifr ",.t fAN 11"1 Y"rn,)"CON(I r.11,A'1 W "'
<br /> ,z-aI a-Ia UT-let In the units specified for each parameter us u;.pr.pu.Ne 1)• , t n,!,•1 v hk.:.to L,.,, ,, 1 n,
<br /> —'----------'------- -- — — — ---- asterisks. "AVERAGE" is average computed nvJ r n,tool I—, ,;,. It j,•r, ry,c,at u,h "MA
<br /> t i and"MINIMUM" are extreme values obst-rvtd durum the iti„n „•I.
<br /> Q't 39A t' 1211 3. Specify the number of analyzed stimpley Thal ca,,r,l It,r ,xl; „mnu.nnu..} .q,f,:r•f,•rut )
<br /> S r l _ PERMIT NUMtaEN— -- �DIS sic LATITUDE --LONGITUDE — Specifpermity
<br /> frequency
<br /> in the columns labeled"Nu t, i I1 ,mnr, ,,, r
<br /> —, 4. Specify frequency of aauly sls for each pia amel„ oNo (, & "J'7" I•. r•p,r.o
<br /> 12a-zn Izz-zm Iz+znl Iza•zTl Ize-zel Isc-aU lent to 3 analyaos perlonaed every 7 Jaya) If—taltu,nt: r!.t ,,):,I "
<br /> -- ----- S. Specify sample t/pe("grate"or"---hr. conyra�Irr") .,+ uppi,., „ If ILrt•qu," wua cnnh uu:•u s,
<br /> enter "NA".
<br /> REPORTING PERIOD. FROM Y I + 1 TO I 1 6• Apprupuale signature is required on bottom of Ih tone
<br /> �— �' — - 7. Remove carbon and retain copy for your recurds.
<br /> YEAH MO DAY YEAR MO DAY B. Fold elan dolled Imes, staple and mail Ou•Trial h,ofllre sn,il,•d uJ t
<br /> --- -- ---- -- B P I, I I,n,m
<br /> -
<br /> (3c.d-1y) QUANTITY (I card only) CONCENTRATION rr,� cN:_Y
<br /> PARAMETER �!B 1 !
<br /> A61 I+0-eel (01-e ll Pot-6a lee•+al Ib-eel ,eA_aU u SAtA1'I L
<br /> —_ -- _ _ _ _.— �— . GF
<br /> i
<br /> MINIMUM AVERAGE MAXIMUM UNITS NO, — MINIMUM AVERAGE MAXIMUM UNITS !tl qqA L'i SIS Ill`
<br />' I 1 1 'I :,f)•1 ,IJT I REPCRIED U 0+�� Qbf(. # # it # # # # # # # ii ., i ' i / / /Al
<br /> ---- - --- - - ------ MGD — — ------ ------ t ,;I) - - - - - -
<br /> PL-H`.,I r I
<br /> 0
<br /> r I CORD,IION 1/
<br /> G REPO
<br /> T
<br /> 1 I i•-`r1 I IT �I H rED # t! ii # # 4It AtiM # # It # # It
<br /> ,�3 3 u, # # IJ i; I ; 1•i• � �
<br /> KG/DAY - — ----- --- - /L
<br /> PEI.I1,T rt IIIIt # 4 It It# # # # it i} # v # # # # 1t # # It) !I
<br /> " CONOI ilOrr —
<br /> I I
<br /> IC 1 I )T�L rill NEPOR TCD # # # tr # # It It It # #
<br /> --P E HMI r -- ------- ----- -- K G/DAY --------- -------- ---- - r-/1_
<br /> # Isr sr # It 4 # # # # l► # # It # # # it # 30
<br /> i I coNfnl;oll '
<br /> • !!11'h,1 (Q'i f ' ) REPO"IeD # {r #--# -# # #-# - ft St # # -#-# A # -�+U�--- d'OL - - f
<br />} i - - - --- — - Kai/DAY
<br /> PEril ltT '
<br /> - CONOI I IOrI it # # # # 0It # # �t # ♦F # # # # { rj
<br /> REPO.IED # # # it # '.t # It It # # # 7.6 1t # # # 8.0
<br /> -- - ------- - -`----' -----' rSU -------- ------- ------- r-t I
<br /> L •_ cONOITION 4 G # It # # it # # # # # 6,0
<br /> 'j
<br /> ' h Ijl•f G=,��Ifl��lil nEPURILD G # # # # 1% # #- it
<br /> i
<br /> PCf„1,1
<br /> RLV OR TGD
<br /> CONDITION
<br /> REPORTED I
<br />� PFGiMIT
<br /> NAME OF PRINCIPAL EXECUTIVE OFFICER TITLE OF THE OFFICER DATE f j
<br /> ------- ----------------------------- --- ----------------'--------------- - - I certify that(am /tunlllar with the fn(onnellun contained in Ihrs
<br /> ^G� report and that to the best of m knowledge and belle(such in(or- d-- —
<br /> r:f v r a -
<br /> _ matiun is true, wmplete,and accurate. 51uNAtuRt of 1-(:INCIPAL ExLl.uTlvt
<br /> LAST_--. ---FIRST--_---- MI__-- -__-'--�-TITLE -- YEAR MO DAY- - —_ ----- _-_--UF Fir ER OR ALI II,URIZtp AGt Nf
<br /> i EPA Form 3320.1 00.72) PAGE OF
<br /> • ORIGINAL 1 1
<br /> li I ` t • _fI.1-!) M U W WATER FRJM !..S. Woof) MINE 43 ANY SINGLE GRAB Ck,4140
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