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PERMITTLE /ADDRESS (111('lude NA'IIUNAI I'(11 I i'111'.I IIAII(;1 I I IMIIIA I.11-!;V'.I'i M(1��1�1 ES1 • form <br /> FacilN-vNamel" «/nifdlll(renr) DISCH G MONITORING REPORT !/Lt//t/ Approved <br /> OMB Noo..204040-0004 <br /> n—r—r—t tL�—.� FINAL Approval expires 9-30-85 <br /> Al ElF SECT. 16 P<OR=10YR24HR <br /> PERMIT NUMBER DISCMAR......EN <br /> /'AEI LITY <br /> MONITORING PERIOD <br /> ------ YEAR MO DAY YEAR MO DAY <br /> LOCATION _-------------- FROM (� 12 0 1 TO b u 1 1 1 M I NUR <br /> (20-21) (22-13) (24-25) (26.27) (28-29) (30-31) NOTE: Read instructions before completing this form. <br /> uencY <br /> PARAMETER <br /> (3 Card Only) QUANTITY OR LOADING (4 Card On/-) QUALITY OR CONCENTRATION <br /> /46.53/ (-54-61) (38-45) (46.53/ (54.6/J NO. FREo ar SAMPLE <br /> /31-371 EX ANALYSIf TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX (ALV II (6YPE <br /> PH SAMPLE <br /> MEASUREMENT <br /> 00400 1 0 PERMIT## # # ## L �j 6 {� y�+REQUIREMENT vim^ t. #** 7*0 fR - K�R,V <br /> ski <br /> AXINUM <br /> SOLIDSP SETTLEABLE SAMPLE <br /> MEASUREMENT <br /> 1 - <br /> `-� �y t-.00545 1 0 PERMIT # ##* REPORT 0*5 <br /> REQUIREMENT I <br /> 1� t� <br /> 1-- <br /> OIL AND GREASE SAMPLE <br /> FRE ON EXTk-(;RA V METH <br /> MEASUREMENT <br /> 0055 1 PERMIT , ,. „ ' REPORT 10 R CK yG `Dr <br /> M1,7, <br /> REQUIREMENT <br /> FLOWv IN CUNDUIT UR SAMPLE <br /> THRU TREATMENT PLANT <br /> MEASUREMENT <br /> 50050 1 0 PERMIT REQUIREMENT RE Rf REPURT N EKLYI STAN' <br /> FGROSS <br /> SOLIDS, TOTAL SAMPLE <br /> DISSOLVED (MG/L ) MEASUREMENT <br /> 70295 1 0 PERMIT REQUIREMENT REPORT REPORTEFElIff-blT GRIDS-, Val Hy: <br /> y- Q RLF G A� <br /> VISUAL <br /> L AND GRc ASE SAMPLE <br /> • Igc�(c capc plc 7oC 7�7�C 7�C* �k#1## ##Ik# �k <br /> ISUAL MEASUREMENT 84066 1 0 PERMIT <br /> REQUIREMENT t EPOtl <br /> _. <br /> YE S=1 Ik## # # # �' !: # .'* {N� •� Iy�LY JVN Vt <br /> nAILY .L X1L I , 9 .- <br /> C <br /> #* <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNOER PENALTY of Lww THAT I HAve Pe R.-LLY ¢%AMIN ED <br /> INo AM FAMILIAR wrrH THE InF OR Mwnon suBMlrrcD HEReIN wnD BwsIo TELEPHONE D A T E <br /> J©�,� Q � Ory MY INo THE for rHose I^„vFIDuw Ls IMMEDIAT¢LY we NnFso a POR � ^ <br /> 7 {{i/rr/) oBrwlnlnc rN¢ nFOw Mwrlo N, I Beueve rHQ suB MITTID Aon <br /> !� , Is TRUE, Accu ww rc A.D o -re. I w wwwRE THAT THERE I ARE SIG- <br /> T.P wlilE9 POwL SUBMITTING MLl" POw MATZO N, NG <br /> THQ PO¢¢IBILITY DP PINE ANO IM Pw ISO NMQ HT, ¢¢Q 1• U.•.C. §N 1001 RIND ^� <br /> o� u.s.e. § IpIL. (Penahies undcrthcse smrutesmay includefinesup to$10,000 SIGNATURE OF PRINCIPALEXECUTIVE J <br /> - - TYPED-ORPRINTED - mldfor maximum imprisonrnrnfbflietKecn6months and Syears.) - OFFICER OR AU THORIZED-AGENT AREA <br /> CODE NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (RcJcrcnce all attachntentshere) <br /> IF t4 UIS(,HARGE OLi;URS KEPUkT "NU DISCHARGE" SALINITY SHALL BE MEAS.AS TUS+70295 MG/L. <br /> U&G NUW 2 PRAM .NU SHE EN:84066=0056=0 .A SHEEN:8406d=1t556=GRAB SAMPLE . <br /> EPA Form 3320-1 (Rev. 10-79) PREVIOUS EDITION TO BE U CD (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.( <br /> UNTIL SUPPLY IS EXHAUSTED. PAGE OF <br /> U1242/CliL886-1527 1 <br />