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P}zi+M IT ALE/ADDRESS (Include <br /> 0 PERMITTEE NAME/ADDRESS (Include NATIONAL.POI-I-IITANT DIS—ARGE ELIMINATION SYSTEM (ATI)1:S/ Form Approved <br /> FacdityNante/Loc'atinnifdiJferenr) DISCHARGE MONITORING REPORT/l)MR) <br /> NrrYiE M1{1-Ci1111T16LElYT C[lAL �_C:t10E CU ___ 2-16 17-19 _ OMB No.2040-0004 <br /> F — FINAL Approval expires 9-30-85 <br /> ADDREssRn c,H_-_--______ CIF10000,496 004 A SECT. 17 EFFECT AT ALL TIMES <br /> CARBUNDAI { ---__— C" H 62-a _ PERMIT NUMBER DISCHARGE NUMBER <br /> '----'-------- MONITORING PERIOD <br /> t<ACILITY � ------- <br /> �-�--'-- ------ YEAR MO DA I YEAR MO DAY <br /> LOCATION ------ FROM 8 D 1 TO 88 1Z <br /> MINOR <br /> (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 Only) QUALITY OR CONCENTRATION FREQUENCYPARAMETER / NO. SAMPLE <br /> (46.53) (54.61J (38-45/ /46-53/ /54.61 <br /> (32.37) >< o <br /> EX AN ALY SIf TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62.63 (64-68) (69-70) <br /> PH SAMPLE <br /> MEASUREMENT <br /> PERMIT T *7p".7oC>OC,*7dC 7�*7(k*`,** >iCl0. <br /> 00400 1 O yy,��. //��, �+{� yt <br /> REQUIVAL [IF,ItlrREMENT 6B5 'EFT •W W EK.11 1� <br /> �+ ## <br /> SOLIDS, TOTAL SAMPLE ### ### # <br /> -- SUSPENDED MEASUREMENT r C `{�1 <br /> 00530 1 O PERMIT * #* *# * * ## :/ 70 C�f G Mq <br /> REQUIREMENT s <br /> OIL AND GREASE SAMPLE <br /> FREUN EXTR-GKAV MET MEASUREMENT <br /> 00556 1 0 PERMIT REPORT 10 {r <br /> REQUIREMENT <br /> p('� <br /> I - ,y <br /> IRON, TOTAL SAMPLE r11cI171C >y�pc>in�c>�cspc *##*# <br /> (AS FL- ) MEASUREMENT y,f,�a ryF� <br /> 01045 1 V PERMIT --#* #M * * * 1 B0 G.0 <br /> REQUIREMENT Q <br /> VA, lip <br /> FLUW9 IN CONDUIT Oft SAMPLE <br /> THRU TREATMENT PLAN7MEASUREMENr <br /> 500 50 1 0 PERMIT REPORT REPORT -W 'EKI.YI $TAA!`.: <br /> REQUIREMENT - <br /> SOLIDS, TUTAL SAMPLE * * # * * <br /> DISSOLVED (MG/L) MEASUREMENT <br /> 70295 1 0 PERMIT kEPORT REPORT.° <br /> ���*�# �*It#*� #�� �#��*� <br /> REQUIREMENT <br /> FI UL�F�NT _, -- <br /> 900A AV <br /> OIL AND GREASE SAMPLE Ipnpc�►c>�c:pc # �pcxc>gc>Oc 7oC:pc�pcY�c:pc 7{C>IC71C7QC#7[K <br /> VISUAL MEASUREMENTEF-E L` �y i,1� L <br /> 84066 1 0 PERMIT R EPURT ** #Ik E$_1 * # *### # # * # ( e�([p <br /> REQVIREMENT - N EKLYV UAL <br /> j U F N T _ S _=_0- #16c>gc <br /> NAME(TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY of LAW THAT I HAVH PERSONALLY EAAMINRD TELEPHONE DATE .. <br /> AND AM FAMILIAR WITH TIIC INFORMATION SUBMITTED HEREIN AND tlAffD <br /> INQUIRY OF TMOfH INOIV IDUA Li IMMEDIATE—CDIATi LY REf PONfItl LP- FOR <br /> Is TAININO THE INFORMATION, 1 BHLIEVE THE iVBMITTiD INFO±MATION G <br /> V /V i` ••_vr`�/ 7 (1 ! TRUE, ACCURATE ANO COM TE. 1 AM AWARE THAT TNi RE RE <br /> NIFICANT PENALTIEi I. iVBMIT TIND FALiE INFORMATION. IN CLUDIND <br /> &*Zip <br /> THE.POffI-1— OF FINE.AND IM.PR nON MINT. SEE — U.—. I IOOI ANO - � j <br /> )f U.S.C. § non. Penalties under thesestatutes may SIGNATURE OF PRINCIPAL EXECUTIVE <br /> _ ( y include fines up to$IO,000 <br /> TYPED OR PRINTED and/or maximum imprisouncnt ofbehceen 6 nnonths and Sycars./ OFFICER OR AUTHORIZED AGENT AREA CODE NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> IF NO DISCHARGE OCCURS REPORT "NO GISCHRGL" ON YOUR DMR .FLOW 1S MEAS.AS MGL?:;:MILL10N GALLONS PER DAY. <br /> SALINITY MCI:.: .AS TDS=70�-95 MG/L. ?- PRAM FUR U&G Nil SHEEN :84066=0.556=0,A SH E LN :84U66=1 P 556=GRABI SAMPLE. <br /> �.i -+ PR[VIp U^ FnlTlnv rn R v°.I-o rl ,�I r A Fn WA T-nn WHICH MAY rirj4 Ur. USt,D 1 PAGE OF <br />