Laserfiche WebLink
PERMITTE GjADDRCSS (include NATIONAL I'OI_�1'1'UISc.11ANGL [LAMINA I ION%YSTEM(NI'DLS) • Form Approved <br /> Facility Ncnt 1 tion ifdifJerent) DISCH) I, MONITORING REPORT jAWR) <br /> OMB No.2040-0004 <br /> «IA+^±—MIIZGliNIIrL LLi LLUAL S 13ic_C_U_ .—_ 1 7-19J F — FINAL Approval expires 9-30-#5 <br /> ADDRESS ,�_ _— SLLT 11 PRECIP .<OR=10YR24HR <br /> PERMIT NUMBER DISCHARGE NUM DEH <br /> --^-- -----tJ----- MONITORING PERIOD <br /> FACILITY <br /> ------- ------ YEAR MO DAV YEAR MO DAY <br /> LOCATION ---_--- FROM TO jI MINOR <br /> LNV C RD (20-21.) (22-23) (24-25) (26.27) (28-29) (30-31) NOTE: Read instiuctions before,completing this form. <br /> (3 Card Onll'J QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46 53) (54.61) (38.45 NO. SAMPLE <br /> ) (46.53/ rweoueNCY <br /> (32-37) (54-61J EX or TYPE <br /> ANALYSIS <br /> p AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64-68) (69.70) <br /> PH SAMPLE XF F *%t yk flit## .;.5 / D W \ <br /> '. MEASUREMENT / <br /> 00400 1 U PERMIT 6*5 9.0 W EKtYG AB'. <br /> EFFLLI REQUIREMENT *# <br /> SOLIDS* SETTLEABLE SAMPLE D �� �� <br /> MEASUREMENT <br /> _= 00545 1 0 PERMIT '#*##*�. *## # * ****** REPURT 0.5 0 C E/ ''G <br /> REQUIREMENT <br /> ------ ** —_ " UDA AVG <br /> OIL AND GREASE SAMPLE <br /> FRE014 EXTk—GRAV M�� MEASUREMENT � l�D �I.o D WK G� <br /> 00556 1 O PERMIT �k%3�G7�*�C #�k#### TM M �k##*## RE PORT IU + <br /> REQUIREMENT ## i% WEEKIYG A.BFLOWEFFLUENT GROSS VAIJL <br /> THRUyTREATMENTIN IT OR PLAN- SAMPLE MEASUREMENT 0 J` /Y Dg�� • /4� D W L JN <br /> 50050 1 O PERMIT REPURT REPORT t���KIYI <br /> REQUIREMENT <br /> SOLIDS , TUT�AAL SAMPLE �'� <br /> DISSOLVED (Mb/L MEASUREMENT � � Ole <br /> 70295 1 0 PERMIT REPORT 4tEP0lit" ��V//Q i.Y G ��J�////����> <br /> REQUIREMENT * - <br /> OI L AND GREASE SAMPLE � /'�' <br /> VISUAL MEASUREMENT • © WK V / <br /> VISUAL r VVVV „ i'1 <br /> 8406G 1 O PERMIT R SPORT ***#** YES-1 ** * # ** #### * *# N .„EKE.YV $UAL <br /> REQUIREMENT <br /> [}A 1 LY MX._. NU=O ### <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT � ' <br /> REQUIREMENT tl <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cIRTIFv UNDeR PENAI.ry OF IA. TRAT I HAVe PERSONALLY ..AMI... <br /> AND AM F MILIAR wIT. <br /> 1'HC INFORMATION SUBMITTED NfiRCIN AND BA..O TELEPHONE D A T E <br /> vOh'N �. ON MY INQUIRY INP TIIOfiE INOIVID-11 IMMIOIATiLY gEfPON31Bl! PON <br /> I\I}n•Pr�-/Tn``V\ OBTAINING TH! FORMATION• 1 B ILIA VIMT H E ASIUBM,^TED INFORMATION I <br /> IS TRUE, ACLU RAT. AND COM PLC Te. I A AW . TI T T FRG ARE S1 <br /> TIP-- PENA LTIfi9 POR SUBMITTING PALS! INPORM ATIO • IN CLUDINO <br /> TIP-- OP rlrve ArvD IMPRISONMENT. SEE I. U.S.C. § IaBI AND SIGNATURE OF PRINCIPAL EXECUTIVE "V /�T�l �� f <br /> » U.s.C. § 1 '.. (Penalties under these+statutes may include fines up to$10.000 _ <br /> TYPED OR PRINTED andJor nmxinlu m imprison lent of between 6 rnon the ands curs. <br /> j. ) OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> CODE <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> IF NU DISCHARGE OCCUKS REPORT '$NU DISCHARGER .FLOW . IS MLASeAS MGU=MILLION GALLONS PER DAY. <br /> SAL1NLI1Y I'11:ASeAS TUS=70L95 My/LIS2 PRAM FUR U&G NU SHEEN:84066=U#556=09A SHFEN: 84U66=Is556= GRAB SAMPLE. <br /> UNTIL SUPPLY 1 EXHAUSTE D. <br /> EPA Form 3320-1 (Rev. 10-79) D (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br /> 00068/0e28 iF-1527 1 <br />