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i <br /> PERMITTE FIADDRESS (Include NATIONAL 1101 1,I I u11t IlARG1-L I.IMINn'140N SVSI'I;M 17'11/iSl FormA Ap <br /> proved <br /> pp oved <br /> Facility Name <br /> tionifdlJfcvent/ DISCI �[: MONITORING REPORT i1);1/K/ OMB No.2040-0004 <br /> IJrM6 h11T l)+(, rl r�-n,[�-I- '-(rQ L -L.(.21L__1..11--------- -.-----(_.'ll,I---- _---fl7-Iflr F -- �-INAL Approval expires 9-30-85 <br /> ADDRESS(—{A_ �_-------_ _�,� SEGT 21 <UR=10YR24HK <br /> -- LdRE3i NiIAL i;----_— ELI d 1 ( �_-- PERMIT NUMBP-R UI:SIIAROE NUM.ER <br /> i <br /> ---------- ------ MONITORING PERIOD <br /> FACILITY__ - <br /> - ------ YEAR MO I DAY YEAR MO DAY <br /> FROM <br /> LOCATION <br /> -------------------- TO 1 MlNarc <br /> (20-21) 122-23) (24-25) (26-27) (28-29) (30-31) NOTE: Read instructions before completing this form. <br /> (3 Card On;p) QUANTITY OR LOADING (4 card Only) QUALITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> PARAMETER /46-53! (34-61) (38-45) (46.53) (54-61/ or <br /> (32.37/ — EX wgwlYsls TYPE <br /> (`,�1 AVERAGE <br /> y — MAXIMUM UNITS MINIMUM AV EyRAGE MAXIMUM UNITS EX (ALYS (6YPE <br /> PH SAMPLE C1=r T 41:*4c-4 <br /> MEASUI7LMLNl' <br /> 00400 1 0 PERMIT #�G # ## T IF >a .0 hTE KLY� AFi REQUIREMENT <br /> SOLIDS, SETTLEABLE SAMPLE <br /> MEASUREMENT <br /> 00545 1 0 PERMIT #% #tk # REPORT 005 0 CE! <br /> _ REQUIREMENT <br /> OIL AND GREASE SAMPLE 7oi 7�JdC�cxc sx 7p[7R ������ <br /> FREON EXTR—i RAV MLT` MEASUREMENT <br /> 00556 1 0 PERMIT �pc>f�tc>�cXlc;lc #>� * �1� �L � # �x REPORT 1G W i:K1;Y6 AB` <br /> R EQVIREMENTFFFIU � —_—_ J.[l'l1 _ <br /> FLOW, -1N CONDUIT (JR SAMPLE ' * <br /> MEASUREMENT <br /> -THRU TRrAlt'�ENT PLANT <br /> 50050 1 0 PERMIT L t;R T REPUR { ## �R�kW ( # #�01 k# #sic •* * WEkKIYI $I REQUIREMENT <br /> SOLIDS ] TUTAL SAMPLE j *v*** <br /> DISSULVLU (M6/L MEASUREMENT <br /> 70295 1 0 PERMIT REPORT REPORT Q L.Y :GFlzFl AB,REQUIREMENT <br /> LRGIL <br /> I. 1� — <br /> OIL ANO GKtHSE SAMPLE *#Yx <br /> ' I � MEASUREMENT <br /> VISL;AL r <br /> 84066 1 0 PERMIT R LPURT # YES=1 # # * * W. 'EKLYY SUAl. <br /> EFFLUENT r REQUIREMENT # <br /> DA LY__A)L <br /> SAMPLE <br /> MEASUREMENT . <br /> PERMIT . <br /> REQUIREMENT <br /> NA%IEITITLE PRINCIPAL EXECUTIVE OFFICER c<RnFT u oLa PEnw Lrr oP LAw Tn AT I HAVE PEA SONALLV EAAMINED <br /> f1 AND wM PAMI+LIAR WIT. TNe INFORMATION sue MITTED .-IN AN. BASE. TELEPHONE D A T E <br /> �J'Z � //{�� ON MY INO DIRT OF <br /> TI <br /> THOSE INDIVIOUA L• IMMCDIATE LY RESPONg1e LH IOR <br /> V O l � • OBTAINING TNL INPOR MATION, I EELIIII THE SUBMITTLO <br /> RU INFORMAON <br /> / I! TL, ACCURATE ANO COM PLHT E. 1 AM AWARE TN AT THHRL ^RE SID- <br /> `• PENA LTIEg POa SUBMITTING FALSE INFO a MATZO N, IN CLUDINO <br /> TnH PO SSIR1 LIry OF FINE AND IMPRISONMHNT• SEE IS U.S.C. 6 1001 AND _ f <br /> (^ 33u.S.C. 1 loll. (Penalties under these Statutes mac ��/A <br /> include SIGNATURE OF PRINCIPAL EXECUTIVE J�/// <br /> TYPED OR-PRINTED - - and/or maximum imprisornncnt of-between 6 rnontlisand 5 years.) OFFICER OR AUTHORIZED AGENT AREA <br /> CODE NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Referenceall attacllmentshere) <br /> IF NU DISLHARGE LLLURS KEPORT "NU DISCHARGE" FLOW IS McASISAS MGLI=MILLION 6ALLENS PER UAY. <br /> SALINITY MEAS.AS TUS=70Zy5.2 PKAM FOK ULG. <br /> EPA Form 3320-1 (Rev. 10.79) PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USCD.1 <br /> UNTIL SUPPLY IS EXHAUSTED. PAGE OF <br /> • co-rc���L��r�t36-151? 1 <br />