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PERMITTEE E/ADDRESS (Include NATIONAL POLLU DISCHARGE ELIMINAIION SYSTEM (,`'/'Ol..1) ormApprovod. <br /> Facility Nam lion it di.rJrrrn+) DISCHAF MONITORING REPORT (041R) qwMB No.2040.0004 <br /> NAME 1M I U-C U N T I N L.N T I,UA L L L UK E C U _—, (,.u,l (I7.19) r: - FINAL Approval expires 9-30-85 <br /> ADDRESS tiOA 158 _ COUCOQ396 0' fi SECT 10 <UR=10YR24HR <br /> ——— CARBLINUALE ----___ GO 81d23 — PERMIT NUMBER DISCHARGE NUMBER <br /> ------------ <br /> —————————— MONITORING PERIOD <br /> ��ITY YEAR MO DAY YEAR MO DAY <br /> LOCATION FROM U TO MINOR <br /> A (T N: U UU G LA S bOWMAJ49 ENV L WRp (20-21) (22-23) (24-25) (26.17) (8-29) (30.31) NOTE: Read instructions before completing this form. <br /> PARAMETER (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY O) CONCENTRATION FREOUENCv <br /> >< (3845) (46-53) (S46!) NO. OF SAMPLE <br /> (32-37) EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> (62-63) (64-68) (69-70) <br /> Pet SAMPLE * *** * #* <br /> MEASUREMENT . <br /> OU400 1 0 PERMIT 6.5 ****** 900 MEEK GRA6 <br /> EFFLUENT GROSS VAL —REQUIREMENT <br /> M I'mi sl-u-; MAX IMI IM -"s'i I <br /> SOLIDS9 SEllLEABLE SAMPLE <br /> !, ` 7 r� MEASUREMENT L t, ry_ _00545 1 0 `` PERMIT ****II�R * **** >�**** REPORT 0*5 p <br /> OIL <br /> GROSSrAL REQUIREMENT ONCE/ GRAB <br /> OIL AND GREASL SAMPLE <br /> MnN <br /> FREON EXTR-GRAV MET VEASUREMENT <br /> 00556 1 0 PERMIT ****** * *** ****** REPORT 10 MEEKL GRAB <br /> EFFLUENT <br /> ,,, 1 Vt T GKass .REQUIREMENT <br /> ** <br /> FLOW„ IN CUNDU I T UR SAMPLE <br /> THKU TREATMENT PLANf <br /> EASUREMENT <br /> 5005U 1 0 PERMIT jlf-)URT REPORT ****** ****** ****** **** WEEKL IN5TEFFLUENT GROSS VALLJ A <br /> .REQUIREMENT <br /> SOLIDS II TUTAL SAMPLE <br /> DISSOLVED (MG/L ) MEASUREMENT <br /> 70295 1 0 PERMIT *****, ***)wt* ** ****** REPORT REPORT QTRLY GRAB <br /> -EFFLUENT <br /> - .s, EQUIREMENT <br /> OIL AND GRCASE SAMPLE * * * * *** <br /> VISUAL MEASUREMENT <br /> 84066 1 0 PERMIT REPORT ****** ES=1 ****** ****** ****** **** NEEKI VISUA <br /> EFFLUENT EQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT T-1 <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED TELEPHONE D A T E <br /> 1'♦/ -�../.,���• ON MY INQUIRY OF THOSE INDIVIDIIALS IMMEDIATELY RESPONSIBLE FOR <br /> 9-0 J; yg/ OBTAINING THE INFORMATION 1 BELIEVE THE SUBMITTED INFORMATION O '^ <br /> IS TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG / <br /> TH ICANT PENALTIES FOR S IMPRISONMENT <br /> FA SE INFORMATION INCLUDING <br /> /lyl /IVO L{ THE POSSII ITV Of FINE 4N0 IMPRISONMENT SEE 18 USC 4 1001 AND <br /> .- 33 uSc- 51319 rP.•nahu•.. under the..• sw w, , uu huh, SIGNATURE OF PRINCIPAL E CUTIVE <br /> mul ur manmum— r I n fur.. up L. Slu uun <br /> TYPED.OR PRINTED pn.ur nr.n /h.•ruw n 6 m nth !.yl5.r•n r.r - OFFICER OR AUTHORIZED AGENT -A EA <br /> NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Ref,"crIe all uuuJnnenls he+r) ConF <br /> IF NO CIIS(,HAkG- UCUURJ> REPORT ISNU DISCHARGE".SALINITfY ShALL BE MEAS.ASTUS=70295 MG/L, <br /> 0£.G NOW 2 PRAM.A SHEEN :84060=1,55u=GRAL3 SAMPLE.NJ SHEEN :84066=01550-0. <br /> EPA Form 3320.1 (Rey- 10.79)PRrVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) �^s `shy UNTIL SUPPLY 15 EXHAUSTED 00:54(i/10 06 8 6-1 6 46 PAGE 1 <br /> OF <br />