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PEP M I TTE�E/ADDRESS (Include NATIONAL POL IT DISCHARGE ELIMINAPION SYSTFNI(AIDLJ'1 Form Approved <br /> Facilitvhame! ioitifdifferentl DISCH*E MONITORING REPORT tl)1110 , OMB No.2040-0004 <br /> FINAL Approval expires 9-30-85 <br /> SECT. 5 <OK=10YR24HR <br /> CA _ r�, j�`� _ PERMIT NUMBER D ISCHARGE NUMUEN <br /> MONITORING PERIOD <br /> FACILITY_ <br /> —�'--------------- YEAR MO DAY YEAR MO)l DAY <br /> LOCATION FROM 88 12 <br /> 0 1 TO _8 I IL 31 M 1NOK <br /> ATTN: DOIWI AS ROW A, (20-21/ (22-23) (24-25/ (26-27) (28-29) (30-31) NOTE: Read instructions before completing this form. <br /> (3 Card Onlyf QUANTITY OR LOADING (4 card Only) QUALITY OR CONCENTRATION FREQUENCY PARAMETER (46.53) (54-61) (3845 RE <br /> 1 (46-53) (54-61) NO. QP SAMPLE <br /> 32.3 7 1 EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64.68) (69.70) <br /> PH SAMPLE <br /> /� /� <br /> MEASUREMENT <br /> 00400 1 0 PERMIT * * TTT <br /> GROSS REQUIREMENT 6. * ws+ WEEK AB:; <br /> MAXIMUM rll <br /> SOLIDS, SETI LEABLE SAMPLE <br /> MEASUREMENT <br /> -- 0054� 1 0 PERMIT K'PORT 0.5 -:G AB <br /> REQUIREMENT <br /> EEFUIEUI <br /> GROSS VLI [IV <br /> /�r' I� %6�sIK <br /> OIL AND�/V(f'EASE l' L SAMPLE 7a�C7�/�QC7p 7QC ll[71C 7k��**� <br /> FREON EXTR—GRA Y ME•( MEASUREMENT f y <br /> 00556 I U PERMIT �k �k# �k {k spc�p* REPORT 10 GI `EKL'YG AEI <br /> 1 1- <br /> REQUIREMENT <br /> FLOW, IN CONDUIT OR SAMPLE <br /> THRU TREATMENT PLANT-MEASUREMENT REPORT <br /> y' yy y.{ y�y� Ir �y�,� y vT c �j 50050 1 0 PERMIT RE OR f �'!SIP f"[`T 7 r TT�T' TT T'1►� T �� � �KL{� J��/r REQUIREMENT - <br /> SOLIDSv TOTAL SAMPLE X�# # �C x1i�C7�7QC J6C J�[7 �C OL�yC <br /> DISSOLVED (MG/L ) MEASUREMENT <br /> 70295 1 U PERMIT REPORT REPORT Q RLY G A� i <br /> # ## ax* * # <br /> REQUIREMENT - <br /> OIL AND GREASE_ SAMPLE <br /> VIJUAL MEASUREMENT <br /> 84066 1 O <br /> PERMIT {,K kPf3R�yT YE:S=1 Y S REQUIREMENT W EKLYUAI. [i <br /> '���##* <br /> t7p T LY MX- _ <br /> �k# <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER "6 LTY o LAW T.Ar I HAve vERfONwLLY ez MINED TELEPHONE DATE I'AND w PAMI LIAR WITH THE INFORMATION SUBMITTED NHglIN AMDAB A9i0 <br /> NOUIRY I THOB! I OIV(OVAL• IMMlOIATE LY RlfPON9101! POR <br /> N MY I D N r <br /> OBTAINING TH[ INFOR MwT10N, I BELIH V! HH BUBMITTED INFORMATION <br /> 0 `,VVV no <br /> NN /R/ _/ <br /> •'/- • I If TRUE, ACCU RA TH ANO OMF MITI;.. <br /> 1 AM AW H TN AT THHR[ A ! 11G- <br /> NIPICwNT IE NA LTIFf FORD 6UB MIT TING PALE[AINI ORMwT ION, IN CI UOING �/ <br /> j1 rH Fo sslBluTv ar PINE wND IM Pn IsoNM inr, s[[ If u.a.c. § Iool wqo SIGNATURE OF PRINCIPAL XE UTIVE <br /> /LJ �n D•f•e• 4 ICI•• (Ycnaltics under these starules may include fines up to$10,000 <br /> AREA - - - - <br /> TYPED-OR-PRINTED and/or'moxurmm-lniprlsanmCnt Of between 6-months ands years OFFICER OR AUTHORIZED AGENT.f - CODE NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rejerence all atiachmentshere) <br /> IF W DISCHARGE UCCUKS IttNCIRT "NU UISCHARGE" SALIIvI�TY SHALL bE MEASURED AS TUS=70295 MG/L. <br /> UEG wUw 2 PRAM .NU SHEEN:84066=0,56=0.A %HELN:8,(+Wt,=1, 556=GRAb SAMPLE. <br /> EPA Form 3320-1 (Rev. 10-79) PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.( <br /> UNTIL SUPPLY IS EXHAUSTED. PAGE OF <br /> U 11 7`1 0/082866-1527 1 Ali <br />