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i <br /> NP A Ml EE_T A NATIONnI. MONITORING <br /> II:LNIMG REPORT Mi I Irl,tl tI/FociityAmC E/ifDdlDffRerLe'rSltS) (Incllldc DISIC , form Approved <br /> LLJ LKLIa �`- L4'_ U 7-l1, <br /> • OMB No.2040-0004 <br /> F — FINAL Approval expires 9-30-85 <br /> ADORE95i{I(x _ , <br /> ------------- " SECT 10 <OR=10YR24HR <br /> -- - {? 7 w:-t PERMIT NUMBER ...ARGENUMBER <br /> FACILITY__ <br /> ------V—i —l—J---- MONITORING PERIOD <br /> ----- YEAR MO DAY YEAR MO] DAY n� r� <br /> LOCATION --------- FROM 8 v 12 <br /> 0 1 TO 88 12 31 M I NOR <br /> (20-21) /22.231 (24-25) (26-27) (28-29) (30.31) NOTE: Read instructions before completing this form. <br /> (3 Card Ott/pJ QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> PARAMETER (46-53) (54-61) (3845/ 46-53 <br /> (32-37J (_ ) (54-611 of <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64-68) (69.70) <br /> PH SAMPLE <br /> /�r1 <br /> MEASUREMENT C t p <br /> 00400 1 PERMIT * 6.5 •0 <br /> �GK4.Y Ail• <br /> REQUIREMENT , *** -. <br /> S O L IDS , S E T T L,E A b L L SAMPLE ,yc <br /> MEASUREMENT <br /> PERMIT Vr <br /> REPURT 0 5 <br /> 00545 1 t) * gat >k >� 13 0 E/ :G AB <br /> L- REOVIREM ENT - • <br /> OIL AND GREASF SAMPLE <br /> FRELbN ExTk— MET <br /> H ET MEASUREMENT <br /> PERMIT REPUR7 10 t� -EKLYG AB, <br /> 0 -�6 1 0 <br /> REQUIREMENT <br /> FLOW, IN CONDUIT OR SAMPLE <br /> THRU TREATMENT PLANT <br /> MEASUREMENT <br /> 5005U 1 0 PERMIT VIP R�' REPORT ��c � #� *� i,i EKLYI 5TAN <br /> REQUIREMENT f +,SOLIDS, TOT/LAAL SAMPLE $)c�Qt <br /> UISSOLVL-V (Mb/L ) MEASUREMENT <br /> 70295 1 V PERMIT(*REQUIREMENT RE:PUR7 REPORT, + LY <br /> - rz/3 I A( lip. 9011A AV <br /> _ <br /> OIL AND GRLASE SAMPLE <br /> VISUAL MEASUREMENT <br /> 84066 i 0 PERMIT K E PORT Y f=S—1 -* �k* u <br /> �' <br /> REQUIREMENT I+! EKLYV SUAL <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER IcERTIPY UNDER PENALTY DP Lww THAT I HAVE PERSONALLY HxAMINHD <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED TELEPHONE D A T E <br /> j�/') NDUIRY OP TIIOSH INDIVIDUAL. IMMEDIATELY E.PON.IBLE <br /> phN ��� OBTAINING THE INFORMATION, 1 BEl1H VH THE yUB MITTED INPONMATION <br /> {/ ((JJ 19 TRUE, ACCURATE AND COM PL CTE. 1 AM AWANE THAT TNER! ARC HIO- <br /> NIPICANT PE NA LTIE! "OR SUBMITTING Fw LSH 111ORMATI1 N, 1N CLUDING L <br /> j� THE POSS6;—TY OF PINE AND IMPRISDNM6NT. HEH 1. U.l.C. § IyUI AND <br /> ,Lvl " u•°X. 4 ICI.. (Prna(tit'e'tutda'rihl•s(,Stalatesnlayinc(ude JLresupio$iO,000 SIGNATURE OF PRINCI ALE TIVE <br /> TYPED OR PRINTED and/or maximum imprisonmen t of between 61non Ills and 5years.) _ OFFICER OR AUTHORIZED AGENT AREA <br /> _ - -. .-CODE NUMBER._ YEAR MO- .DAY-- <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reyerence all attach <br /> nteAlShere) <br /> IF IV(,1 DISCHARGE UCCUKS KtPURT "NL; UISCHAKGE" SALINITY SHALL of ME AS.AS TVS=`t0295 FIG/L. <br /> 06G +4014 2 PRA,,I .NU 5HLEN:840yb=0, 55U=0.A SHEtN: &40b6=11'-�-1 6=6KAL) SAMPLE. . <br /> EPA Form 332)-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 /> Oi42t+/Uts1>w�bb—j527 1 <br />