Laserfiche WebLink
PERMITTEF�E/ADDRESS Include <br /> / NATION AI.POL. IT DIS('l1ARc,f. CI.IfAINAT1eIN�;VSeLM(r�'l'/)1;5/ form Approved <br /> • <br /> FacllityNarne unlifdtJJirent/ DISCH �E MONITORING REPORT Ilrtlli/ OMB No.2040-0004 <br /> N^'"—g—M1U=Li11�LI1 bI.EN LCL1/1 L__L _ C UK E. C LI _ __..._ _._('_crL--._._.._..---. -----I!-'_1'l.. _ F — FINAL Approval expires 9-30-85 <br /> ADaResrIlX ZS�----- _ SECT 8 <UR=10YR24HR <br /> -- -----_C(1 s jh23 _ PERMIT NUMBER DISC HAROE NUMREN <br /> MONITORING PERIOD <br /> FACILITY_ ---------- <br /> ---- YEAR MO DAV YEAR MO DAY <br /> LOCATION FROM <br /> ----------------- 8 12 01 TD 88 12 1 31 MINOR <br /> (20-21) (22-23) (24.2s) (26.211 (28-29) (30-31) NOTE: Read instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card OnlC) QUALITY OR CONCENTRATION <br /> PARAMETER (46.53) (54-61) 38.45 / NO. FREQUENCY SAMPLE <br /> (32.31) ( l /46.53/ (54-61 <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> 62-63 (64-68) (69-70) <br /> PH SAMPLE 7� <br /> MEASUREMENT <br /> 00400 1 0 PERMIT ** * * LL �+yt �+ p <br /> REQUIREMENT V.5 # * .0 G{�4.Y 47 4i -'� <br /> SOLIUSr SETTLEABLE SAMPLE <br /> MAXIMUM— <br /> MEASUREMENT -V(-2 <br /> 00545 1 0 PERMIT REQUIREMENT REPORT 0.5 <br /> OIL AND GREASE SAMPLE <br /> _71C <br /> F —REON EXTKGRAY MLT MEASUREMENT ,4 /� <br /> 00556 1 0 PERMIT #' �( * REPORT 10 <br /> REQUIREMENT W KL�fG f16 <br /> FEUD)W9 IN CONDUIT OR SAMPLE <br /> THRU TREATMENT PLAN MEASUREMENT <br /> 50050 1 0 PERMIT :RVREQUIREMENT REPORT <br /> I� EKIYY SCANSOLIDS , TOTAL SAMPLE7Q171C <br /> OISSOLVEO (M6/L ) MEASUREMENT <br /> 70295 1 G PERMIT REPORT REPORT y <br /> Y rl REQUIREMENT .. Q KL , A4Y <br /> OIL AND GREASE SAMPLE <br /> VISUAL MEASUREMENT <br /> 84066 1 0 PERMIT `R SPORT * **** YES=1 ****** ** k** ** #*# ,* ** Fy <br /> REQUIREMENT W EEKLYVISUAL <br /> x- _ *�a <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cERnrr u F P LAw THAT I "Ave FeR{o nw LLr ExAMIrv{O <br /> wNO AM FAMILIAR wlrH T"e INFORMATION sUaMITTeo HIRFIN Aryo e.{Fo TELEPHONE D A T E <br /> ��r� � �' ory Mr INo TIRE or r lose IN o1v IOU ALs IMMeD1ATELr we avo Nlle Le row \ � ^ <br /> V D OBTAINING T"F INFOR MATT ON I BE61e VF THE {UBMITTFO INFORMATION <br /> I{ TRUE, ACCURATF ANO CAM FLETE. I AM AWARE THAT T. <br /> ARE {IO- <br /> NIFICANT ♦ENALTIES FOR {UU MITTINO FA—K —FORMATION. <br /> IN CLUOIryO <br /> THE roes leluTr OF FINE AN' IMPRISONMENT. {Ee I• U.S.E. § Iool wNo <br /> '•'tJ y(,�•� ao u.s,e. § nls. (Penalties under these statutes may include fines up to$10,000 SIGNATURE OF PRINCIPAL EXECUTIVE (((r <br /> TYPED OR PRINTED - - and/or ma.rimumintplisortmrntnfhelwrrn6mondlr and Sycars./ OFFICER OR AUTHORIZED AGENT AREA <br /> CODE NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (RefIrenceallattachmentshere) <br /> IF NO U1SI7HAkGE OCCURS KEPUKT ntuJ UISCHAKGE'• ON YUUR UMR.FLUW 1S MEAS .AS MGLr=M1LLICIN GALLONS PER DAY. <br /> SALINITY MLAS.AS 7DS=70295. <br /> EPA Form 3320 1 (Rev. 10-79) UNTIL SUPP DV IS XHAUSTE O.D (REPLACES EPA FORM T-40 WHICH MAY NOT RE USED.I <br /> rAGL OF <br /> .GU8t4/UL1886-1527 1 <br />