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PERMITTE E/ADDRESS (111c1llde NATIONAL.I'OI. NT OIS(IIAI7GF ELIMINATION SYSI'LM/AY'U1i$/ Form Approved <br /> FacilityNane ionijdijjerentJ DISC E MONITORING REPORT tDJI tl OMB No.2040-0004 <br /> ME -(:a(YTL�LEN-7^t:IAl- _t:.._.LLKF= CLI_--- -/6 17-1 <br /> F — FINAL • Approval expires 9-30-85 <br /> ADORES _l rj8 -------_-- - S ICT 14 <OR=10YR24HR <br /> G❑ fS11623 PERMITNUMBER DISCHARGE NVMBER <br /> -------------------- MONITORING PERIOD <br /> AEC I LI TY -_ <br /> LOCATION —_ FROM YEAR MO DAY YEAR MO DAY <br /> -------------------- t To 1 M INUR <br /> AT-IN: (20-21) (22.23) (24.2 (26-27) /28-29J 130.311 NOTE: Read instructions before completing this form. <br /> (3 Card OnlyJ QUANTITY OR LOADING (4 Card Oil l') QUALITY OR CONCENTRATION FREQUENCY <br /> PARAMETER ) NO. or SAMPLE <br /> (46-53J (54-61J (38-45/ /46-53J <br /> (32-371 >< (54-61 <br /> EX ANALYSIS TYPE <br /> L� AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64.68) (69-70) <br /> PH SAMPLE <br /> /�/� MEASUREMENT ,,1,. ,A, [� r �y <br /> 00400 1 0 PERMIT ## * �c***�K# 60 �* # .0 W EKLY Wiz <br /> REQUIREMENT * <br /> SOLIDSt SETTLEA6LE SAMPLE <br /> MEASUREMENT <br /> --= 00545 1 0 PERMIT REPORT - 0.5 <br /> REQUIREMENT . <br /> 4< __ <br /> OIL AND GREASE SAMPLE �c 3�tgc�c#a * *�C7Ft>1c*# <br /> FREUN EXTK-GRAV MLT MEASUREMENT - <br /> 00556 1 0 PERMIT —*�**** #* �� ****** REPORT 10 NEEVA, IF KLY ' A8 REQUIREMENT r• y„ <br /> # <br /> FLOWS IN CUNDUIT UR SAMPLE <br /> THRU TREATMENT PLAN MEASUREMENT <br /> 50050 1 0 REP <br /> PERMIT OR REPORT **** * **** * *** * ** it <br /> REQUIREMENT � <br /> ISS 1wjG 1) <br /> SOLIDS, TOTAL SAMPLE <br /> UISSULVED (MG/L ) MEASUREMENT —�- - <br /> 70295 1 0 PERMIT titEPURT REPORT Q TRLY' A ` <br /> REQUIREMENT <br /> # 90DA AV <br /> OIL AND GREASE SAMPLE # *T*### *#*# *TPT** <br /> VISUAL <br /> MEASUREMENT <br /> _84066 1 0 PERMIT REPORT YES=1 **#*#* <br /> W E"y SUA�. <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' ""T" UNDER PE Nw LTT DF LAW THAT I HAv P—.0NALLY EXAMINED TELEPHONE D A T E <br /> •••111 FAMILIAR WITH 1 fi INFORMATION SUBMITTED HfRHIN AND BABEO <br /> ON'r r w INO VIR; pI TH09fi IN OIV IDU AL4 IM MEpIwTELV HEf PON SIB LE PO" ` �^\ <br /> �r+`){ ' I. ANINO THH IT:1A No T10N, 1 BHLIH VH THH SUBMITTED INFO NMATION /'^' <br /> �t�N � I! I„�, AGC TEA EDMPLP. . AT TI'HRH A /���.5/ <br /> NT NALT-S SUBMITTING ALSE AINPOR MATIO N, NCLCDING ���pppq <br /> N PO lS1BILITV of PIN ERw AND IM FRIsoNM ENT, fEH a u.s.c. § Iool wND SIGNATURE OF PRINCIPAL EXE UTIVE V_V �/ "671 / <br /> -' >>r�.s.e. g IlL. (prna;ues under these statutes may include fines up to$10,000 <br /> T Y.P :D OR..P.RINTED and;M masrmuntim rzisnnmento bencr-en.6 nlontlls ands Cars. OFFICER OR AUTHORIZED _AGENT AREA _ <br /> / 1 } / CODE NUMBER YEAR MO bAV <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (11(.l(TI'nce all 41taC1l1n(,n IS llere) <br /> IF NO DISCHARGE OCCURS KEPC'RT „NU UISChARGE" ON YGUR DMR.FLLW IS MEAS .MGU=MILLION GALLUNS PER DAY. <br /> SALINITY MEAS.NS TUS=70295 MG/L.2 PRAM FOR GEG NO SHEEN:84066=0,55b_O ,A SHE EN:84066=1 ,556=GRAB SAMPLE. <br /> EPA Form 3320-1• (Rev. 10-79) PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT 13L USED.) `' IlU <br /> UNTIL SUPPLY IS EXHAUSTED. 00408/ '8 288 6-1 52 7 PAGE OF 1 <br />