Laserfiche WebLink
PERM ITTWIPW <br /> E/ADDRESS (Include NA1IONA I'I nNl LI I':I II AIIIA. 1:1 (MINA 111111'ill,l 1.f.t \l'/)!,.\) <br /> Facility tlanlifdlfjcrent) DIS GE MONITORING REPORT aoij/ 0Form Approved <br /> tLA—m- _ i-111V l T N�L►��1 L �����LL___ /6 OMB No.2040-0004 <br /> 17-1!// <br /> t' � F 1 NHL Approval expires 9-30-8 <br /> ADORESfF{(IX ��_______ SILL]" 11 PREICPe<OK=10YR24HR <br /> — IINI)al F ` j It,, _ PERMIT NVMQeR DISCHARGE N UMBER <br /> FACILITY MONITORING PERIOD <br /> -- YEAREffiXT-1 <br /> YEAR MO DAY <br />' LOCATION 6 FROM3 M1NC1 rc <br /> 120-21) (22.23) (24-25) (26-27/ (28.29) (30-31) NOTE: Read instructions before completing this form. <br /> PARAMETER <br /> (3 Cat III Onit') QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION(31-37/ (46-53) (54-61) (-7Y.451 (46.53) /54 61J NO. FREQUENCY EX ANQF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ALYSIS TYPE <br /> PH SAMI`LE <br /> 62-63 (64.68) (69.70) <br /> �*���� <br /> r� M E A S U H E M E N'r .,4 W ,t,,y .y y,.y.I�. .L.�,,y L� �/ yt/+ <br /> 00400 1 O PERMIT II�T �k*I(K T*TTT* T*C* * ` W §l�`V ii <br /> REQUIREMENT 6�5 ��'��# •Q <br /> SOLIDS9 SETTLEABLE SAMPLE >k * # <br /> /} MEASUREMENT REPORT <br /> {,, <br /> 00545 1 U PERMITFFFIUFNT Il4 PART 0,5 0 EI "G AB <br /> T REQUI:REMENT <br /> c� <br /> * <br /> OIL ANDGREASE SAMPLE <br /> FRE014 EXTk -GRA1V MET I- MEASUREMENT T <br /> 00556 1 U PERMIT REQUIREMENT (SPURT 10 WEEKI.YG AB <br /> - *%� a <br /> FLOW! IN CONDUIT Uk SAMPLE <br /> THRU TRLATMENT PLAN MEASUREMENT 500G0 1 0 PERMIT UKT REPUKT *#*a(ktfa* *** *#**** * ** WEEKLYI ST-0 <br /> R EQUIREM EN7 <br /> SOLIDSs TOTAL( SAMPLE <br /> DISSOLVED (MG/L ) MEASUREMENT <br /> 7U295 1 0 PERMIT # * # Ik#�►:Ik�k* KE1�13RT 'kkPORT ISS VA /'y <br /> EEFI _ _ MI REQUIREMENT RLY G aY <br /> OIL AND GREASE SAMPLE <br /> VISUAL MEASUREMENT <br /> 84066 1 /y V PERMIT K EPORT W EEKLYYISUAL <br /> 1 -FEWENT r, REQUIREMENT' � IP *IQ� * ** <br /> Lali 7�Y MX_ _ *�k�k <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -- <br /> REQUIREMENT 4 <br /> NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I - ITIPV IN— P AUT ��P LAW TNAT I HAVE PERSON"1,1 —Are INfo <br /> AN'IAM AMILIAR WITH TIIE I+IPOp MATION SUBMITTED H N ANB eAf EB TELEPHONE D A T E <br /> SID#� S/� ON MV INpUl of OP TN09E INOIV�OV ALS IMMCOIATELY pEf POLAPSIBLE PON <br /> Iv, V J ' OBTANIINO S,INPOR MATION, I lLIB V TH <br /> ANO I ET :ASUBMITTEOAT <br /> N ENR:^MATZO ��•- <br /> I IS T UE, A AT6 GOM PL4TE. M AW R4 T RE fl0- <br /> "111 ANT PF.NA LTI k'S POR fUB MITTINO PALS.: INPORMATION, IN CLUOINO <br /> THC PO SSIB:L TV P - O IM PpISUNMENT. fE6 Ia U.f.C. § I— A <br /> nN AN. {/rjJl <br /> It',rwltiesunder these statutes may includcfinesup 10$10,000 SIGNATURE OF PRINCIPAL EXE UTIVE <br /> TYPED OR PRINTED and,!nr maximum iutpriswitnent ofhcnaeen 6 months and 5}rars.j OFFICER OR AUTHORIZED AGENT AR.E.A... <br /> COMMENT AND CXPLANATION OF AN VIOLATIONS fReference all attachments here) <br /> CODE NUM BER YEAR MO DAY <br /> IF N,0 VISCHAKGE OULUKS kEPUi-J "IND UISCi-iAkG;-11.FLUW i lS MtASSIAS V1GU=M1LLIGN 6ALLGNS PER IDAY, <br /> SALINITY M'AS.Ta5=70295 MG/LoZ PRAM FUR OGG NU SH&C-N:6406b=0yb56=0 A ShLLN :84066=19556=GRAB SAMPLE. <br /> EPA Form 3320.1 (Rev. 10.79) PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BL USED.)UNTIL SUPPLY IS EXHAUSTED. PAGE OF <br /> - GU30L/Utt2806-15[7 1 <br />