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PERM ITTE19 E/ADDRESS (Include NAT$ONA L.P.0 t_ IT 11I11 A IIGE 1 r.uN nT1.11 Sr STEM <br /> Facility Name/ ahonijd�i�jTjer(en�tJ form Approved <br /> DISCH)R E MONITORING REPORT d).tlk�[IL� w M J • OMB No.2040-0004 <br /> 2-161 17-19J F - FINAL Approval expires 9-30-85 <br /> SGY-1_039d 002 SECT., 11 EFFECT AT ALL TIMES <br /> PERMIT NUMBER DISCHARGE NUM DER <br /> MONITORING PERIOD <br /> FACILITY --- <br /> ------'--------------- YEAR MO DAV YEAR MO DAY r,LOCATION -- FROM TO M 1 NOR <br /> T (20.21) (22-23) (24-25) (26.27) (28-29) (30-31) NOTE: Read instructions before completing this form. <br /> (3 Card Onlyj QUANTITY OR LOADING (4 Card OnlY) QUALITY OR CONCENTRATION <br /> j PARAMETER (46-53) (34-61) (38-45) (46-53J (54-ol) NO. fNcoci NCY SAMPLE <br /> >< <br /> (32.37) EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64.68) (69.701 <br /> PH SAMPLE <br /> MEASUREMENT .000400 1 0 PERMIT 6*5 M E KLY A A, <br /> REQUIREMENT <br /> EFFLUENT GRUS VALUE #�k 1jj _ MAXIMU14 SU1 <br /> SOLIDS1 TOTAL SAMPLE * <br /> SUSPENDED MEASUREMENT TT <br /> 00530 1 0 PERMIT *4�4 p <br /> •NT EFFLU .� .. REQUIREMENT 5 0 VaLUL _ O CEJ �G AB. <br /> OIL AND�yGRLASt SAMPLE <br /> FREON EXTk-GRAY MET F,MEASUREMENT <br /> 005!6 1 o PERMIT Jot <br /> >� REPORT 10 W EKLY...G AB w <br /> /, REQUIREMENT <br /> IRON, TOTAL SAMPLE �k# # >Q <br /> (AS FE ) MEASURE M T f� �y <br /> 01045 1 0 PfiRMIT # *X/ * 1.0 2.0 .•0 � -'G A.g <br /> VALI REQUIREME T - <br /> 1 1, <br /> L, <br /> f LOWt IN LUNDUIT OR SAMPLE <br /> THRU TREATMENT PLAI-41 <br /> MEASUREMENT <br /> 50050 1 0 PERMIT REPORT REPORT W LKLYI STAN <br /> j'�EFFLUENT GROSSVAL is REQUIREMENT I Ty,M, MUD * >� <br /> SOLIDS* TOTAL SAMPLE #Tc *� <br /> MEASUREMENT <br /> M v E G L)USS L V U t /I 70295 1 G PERMIT #yk # Ik#*##IIK REPORT REPORT QTRLY A47 <br /> F UENT GROSS 1 A u REQUIREMENT .- - 7 9OOd� - GIL <br /> OIL AND GREASE -SAMPLE <br /> VISUAL MEASUREMENT i (� t r� c .�,�y.�. <br /> 84066 1 0 PERMIT RkPURT #r� r` ES-1 * #* *** ik>l >� ** 1 <br /> E <br /> W ( r= <br /> EFFLUENT GROSS <br /> '� <br /> REQUIREMENT INU0 * i. sl.;! W,�*a <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER cl nrlrr U"11R Pl rvw Lrr oP Lww Trywr I NAYe veR aoNw ur 1xwMIN10 TELEPHONE "D A T E <br /> w ANO AM PwMIL1AR WITN Try1 INPOR MATION aU.MITTlD NlR1IN wnD Bwf1D <br /> ON Mr INOUI`Y INP Try081 IN DIV Ip VALE IM Mlp1ATELr N!'a PON91011 rOR <br /> /}(li oerwl .. T o rloN, 1 T.- I A 1 cueT rr T Nro R RM <br /> I. rRu1, wccu Rw Ta wNo coM Plare. I wMrw wwRe rN Ar T. <br /> w R. <br /> •c CT `6 <br /> N IPIC wNT PL NA !. PO SUBMIT- PALti IMP ORMATION, INCLUDING -�_-- <br /> p���� PoccIBII". uP PINti IMPNI.ONMINT.1yi I. of es § o 10N0 --- — C& J 9 <br /> u.e.e. § I�Ia. il'I�naltil'S ltnde/IhCSe SlafUfeS may include fin es up t0$IO,000 SIGNATURE OF PRINCIPAL XECUTIVE <br /> TYPED OR PRINTED - andjor maximum iniprisonnletlf ofbetween 6 months and 5 years.) OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY_ CODE <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all atlachmentshere) <br /> IF NO DISCHARGE OCCURS REPORT "NO UISCHARGE" ON YUUk UMR.FLL�W 1S MEAS.AS MGU=MILLION GALLONS PER DAY. <br /> SALINITY MEAS.AS TUS=70295 MG/L. 2 PRAM FUR UGG NO SHEE,% :84066=0t556=0 ,A SHE:EN:8 4066=1 9 5 5 6=GRAB SAMPLE. <br /> F',rS,�f'4D� • PREVIOUS EDITION TO UE USED (REPLACES EPA FORM T-40 Wt1ICH MAY NOT BE USED.) <br /> GrF1 r OOV / p 0 PAGE <br /> UNTIL SUPPLY IS EXHAUSTED, ll0l�6/UV Zt18O-1S17 1 OF <br />