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PERMITTE EIADDRESS Include( NATIONAI.POL NT DISC'HnRG[ LI.IMINnT10N SYSTEM r.�•I'nrsl Form Approved 'FacilitI hl. ionifdt)/erent/ DISC E MONITORING REPORT In111f1 <br /> •1 OMB No.2040-0004 <br /> 6 17-1y F — F1 NAL Approval expires9-30-85 <br /> Q3 96 00- A SELT 5 EFFECT AT ALL TIMES <br /> j;_u_} 6�3 PERMIT NUMBER ulacHARCL NUMDLR <br /> ----------------'" ' MONITORING PERIOD <br /> rwclurr__ <br /> -- YEAR MO DAY YEAR MO I DAY <br /> LOCATION ---------- FROM TO b I 1 L 1 MINOR <br /> rBOWMA (20.21) (22-23) (24-25) (26-27) (28.29) (30-31) NOTE: Read instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Onhy QUALITY OR CONCENTRATION PARAMETER (46-53) (54.61) (38-4-5) (46.53) (54-61) ND• or iR[oulNCY SAMPLE <br /> (32.37) EX ANALYSIS TYPE <br /> >< AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64.68J (69.70) <br /> PH SAMPLE <br /> 1 <br /> 7 MEASUREMENT <br /> 004CK) O PERMIT # # # # # 6.5 * * 9.0 WEEKl.YG AB <br /> REQUIREMENT # * <br /> In MAX IMUM SU <br /> SOLIUSt TOTAL SAMPLE >�>��popc>Oc Ipclpcl�c�pc>� pL <br /> SU S PENU ED MEASUREMENT <br /> 005 30 1 0 PERMIT sj 70 O EJ G <br /> FNT <br /> 7DA[A rK1 <br /> A <br /> _.. - REQUIREMENT _, ¢vy <br /> WO 14 IF, <br /> OIL AND GkLASE SAMPLE <br /> FkE0N EXTR—GRAV METt- MEASUREMENT <br /> 00556 1 0 PERMIT ##**4L* # # **#### REPORT 10 W EKLY AB REQUIREMENT <br /> # <br /> IRON' TOTAL SAMPLE #### # ### ## <br /> y� (A` FE ) MEASUREMENT / �y <br /> OIO45 1 0 PERMIT I * #** # * * #1 T 1.0 2.0 0 E'I <br /> �y LI rr-- REOUIREM EN .-- <br /> F LO W 9 IN CONDUIT V k SAMPLE *#�C # >tc�►c�'>Ic 70C,roL �pc 7007�]a;78C?� <br /> THRU TREATMENT PLANT MEASUREMEN C �+ Ae 50050 1 0 PERMIT ' REPORT k EPOR.T Iw¢ EKLYI STAN <br /> 1�EFFLUENT /-. ../-. _ REQUIREMENT _I �.��,.�1, .LM MG U <br /> SOLIDS, TOIA�L SAMPLE U # # <br /> DISSOLVED (MG/L ) MEASUREMENT y I <br /> 70295 1 0 PERMIT �C7�7�*�C7� � T T7�x( �C ###�x#* REPORT REPORT Q RLY G dot REQUIREMENT _ DA <br /> OIL AND GREASE SAMPLE <br /> VISUAL MEASUREMENT <br /> 84066 1 0 PERMIT k EPURT YE$—1 REQUIREMENT -1!T T * S� K <br /> L Lf;s SVA� <br /> - _ - <br /> 1 Y M Iv * # 4 <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTMY U NAuT oP LAW THAT I HAVE FER¢ONALLY H A MINHD <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED H¢RHIN AND ew is TELEPHONE D A T E <br /> ON MY INO THE OP TH09¢ IN OIVIDV ALg T-Ly TIED <br /> I"1 "M POR ^, <br /> i fi.,.•^¢4•IY( � OBTAINING THE INFORMATION, I Bfi LIH V! TH¢ gU BMITTED INFORMATION ' <br /> IB TRU1, A11URATI AND COM ILHTE. I AM AWARE THAT TH¢RE ARE BIO- <br /> �j..�� NI P ICANT PENALT111 POR SUB MIr'r INO FA111 INFORMATION, IN CLUDINO �� <br /> THE <br /> •08¢IHlllTv OP PIN1 AND IM PRIsOHMHNT. see IB U.B.C. I 1"I AND <br /> SIGN ATURE OF PRINCIPAL EX CUTIVE <br /> rJ Lim rV� >to u.s.e. § IOIo, iP,n;hies under these statuses nmy inrludr fines up to$10,000 <br /> TVRED OR PRINTED and/nr ma.cimmm iny!risnnmrnl of heherrn 6nuniths and S Years./ OFFICER OR AUTHORIZED AGENT AREA i <br /> - _ CODE NUMBER YEAR MO - pAy-- <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS tReji'reticcallattaehntentshere) <br /> IF N40 DISCHARGE OCCURS KEPOKT "NO UISCHARGE" ON YOUk UMk.FLOW IS MEAS .AS MGU=MILLIUN GALLONS PER DAY. <br /> SALINITY MEAS.AS TLS=70295.i: PRAM FOR UCG NO SHEEN: 8406=0,556=G A SHE EN:84066=1 ,556=GRAB SAMPLE. <br /> PREVIOUS EDITION TO RE USED (RLPLAC ES EPA FORM T-40 WHICH MAY NOT BE USED.) �, `' 1� <br /> UNTIL SUPPLY IS EXHAUSTED. G0170�0U2886-1527 PAGE I OF <br />