|
. .....
<br />PARAMETER
<br />(32-37) 3
<br />. -
<br />-:::, ,,...
<br />E.`'
<br />(3 Card Only) QUANTITY OR LOADING t
<br />f46-53) (54-61) - ._
<br />(4 Card 0110) . QUALITY OR CONCENTRATION 1
<br />- (38-45) (46-53) (54-61) •
<br />NO.
<br />EX
<br />(62-63)
<br />FREQUENCY
<br />OF
<br />ANALYSIS
<br />(64-68)
<br />SAMPLE
<br />TYPE
<br />(69
<br />. AVERAGE '
<br />,
<br />MAXIMUM ,..
<br />UNITS '
<br />:, MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />' UNITS
<br />t ri .
<br />•..
<br />Q0 1 0 . 0
<br />iFFLUENT CROSS VALtri;
<br />,..
<br />SAMPLE -
<br />MEASUREMENT a
<br />40 **CT*, ,
<br />t,.:
<br />- ts
<br />i", 0 00 0 0 ::I
<br />'
<br />,
<br />* *
<br />i . •,•;„: :,„".: 41 yr,t ,::: ::1
<br />"
<br />-
<br />> l -
<br />, _
<br />:-; PERMIT.' ■••:,
<br />REouREmENTiv
<br />,...-
<br />- •
<br />- .
<br />.:4 4„0-0 0 4
<br />--_,.. -
<br />.,-, g -
<br />645.,:...i, ,.-. '
<br />i..1**p** 44
<br />9. 0
<br />• PIIIXTritifi
<br />.
<br />•
<br />El
<br />' SETTLEALILF .
<br />-•
<br />L. ,.) 545 I a '-0
<br />... '
<br />;,;71” CRS VAL0 v
<br />SAMPLE ■-
<br />MEASUREMENT''
<br />• ''' I ts** *
<br />--- 0040'00.
<br />.
<br />: •
<br />... .
<br />' 2
<br />,—
<br />t ) 61 '
<br />- 4 0 0. 4 0 *
<br />**: t f.S * f.:
<br />.
<br />,
<br />-
<br />' e
<br />.-
<br />.
<br />F.11/_T.'
<br />•
<br />,- ".:
<br />,
<br />-9 pEiimli, „
<br />EQUIRE
<br />'RMENT
<br />`
<br />„ .
<br />.„-,i, .
<br />'
<br />j'' ..; '
<br />,..?":1,43;(";54, 4 1;.)4.=...=
<br />Va •-•
<br />2 . -' -.9.
<br />s.-i....,44:4 •
<br />*.• ,,,-,,,-
<br />,.....),* 41**
<br />;-,,
<br />..1
<br />T.r'
<br />–
<br />Yi
<br />.
<br />Acli-c
<br />tirfIvr 4
<br />-.J.IL AND GhEAsE
<br />. . '
<br />iBECN EXTR-!GRAV.,METIi
<br />CO556 1. -4-0 - ' -' _
<br />,I. P FLOP N T 41 Npss VA ! rIP
<br />- SAMPLE
<br />MEASUREMENT c
<br />, .•„F a ri" '''•
<br />t .-•; r•Z. _
<br />i "
<br />• *,
<br />fo
<br />*
<br />., 0 0 (g 0 0
<br />:I. 20•*****
<br />•", Z • '''.•:.
<br />,
<br />- 0.-:,•• ,
<br />- •I
<br />i
<br />" C 4. 44•ZI`
<br />•!,
<br />-,
<br />• • ,
<br />,
<br />t. PiAmit'lli.
<br />REQUIRE.Mtwl,
<br />• . - •
<br />,
<br />,
<br />, ',..1 t" "4
<br />4. '.. p - ,
<br />' Ail* a :IN
<br />• --- , a , •
<br />, - rii r•
<br />... .F4 -'
<br />••■ ". 4.4"-'=• ,
<br />- r44. el• '.4.
<br />fl‘, 4v
<br />' Z! 97'
<br />" 4
<br />10 . ,
<br />4 EJ
<br />0 ht.TI RC
<br />R A B
<br />. ,_ .
<br />. ,
<br />Cote W , IN CONpUIT 0 R
<br />el• ii 0 V TREVS
<br />AENT PLAN
<br />1 9 - 00450 1 , - - : 0 :) it; .
<br />,, , . 5.
<br />! rff" GRnSS:
<br />1..
<br />SAMPLE
<br />MEASUREMENT U
<br />Neil '1) 1"
<br />i - ,„; ; _
<br />-7
<br />1 thsal<6 '
<br />i) ?,1
<br />z)LIO i
<br />a:
<br />',',;•:"; 4 0,4 4 0 3 :g .
<br />, I i - - - k '
<br />,..; 0,4 00 04
<br />"....».• :."":-.
<br />e •C I 0 0 0 ' I0Ie.g
<br />,...4
<br />,,. PERMItt zt..0
<br />REQUIREMENT`
<br />r• ,, -
<br />.A:".•, . OR . '
<br />''' -.,. 4 .1.1 ,7 n
<br />,,, K -
<br />ill it 0 a 'If' !":',
<br />• 1 i i . t. *: ., ilia
<br />A • . .
<br />' ' : :
<br />li:oicix4i.I.
<br />''' ' Z.
<br />411
<br />,J
<br />- , .
<br />, ,
<br />-
<br />... .
<br />EEtLV
<br />AISTAN
<br />:i0LIDS, 70iAi--
<br />JISSOLV&D k. -: - ..7.
<br />7025 I :-; 02. --,..,0
<br />%-lfri flFtPr r: lit SN VATrli
<br />. SAMPLE
<br />MEASUREMENT=
<br />...
<br />Cg • 94 00 t••■• 0.:
<br />=. U ',!,
<br />-;', 0400 2 :10
<br />• - -
<br />:
<br />1 : 1 * . **
<br />. ..
<br />.3
<br />- -.., ,;" - --
<br />- :.,..,
<br />.
<br />‘J t-. .
<br />'rtit
<br />, t
<br />.
<br />":-.....• PERMii, -:, I=
<br />EQUIREMNT
<br />PE
<br />- •-,-.
<br />:.:". :"...".-
<br />V' ' lz
<br />4 ...
<br />• - "
<br />',. *••• j: 'm; , .7
<br />' --,' • s l '.--
<br />sillutio ;--:
<br />., . " •
<br />• :f
<br />, simuitl
<br />:" i; -
<br />- UppRiT Z
<br />T
<br />- DAItV 1.
<br />hit
<br />,,..., ,.., ,.,,,.
<br />)IL AND 'ESAS-E r
<br />c'sJ A L 'NJ
<br />•.•:,' ,--••• 'c ,
<br />-.66 I ' 4 ~ ;,.
<br />P F 7 II P NT C q0§ VA t :ii-
<br />- ..
<br />a SAMPLE v
<br />MEASUREMENT •-■
<br />-
<br />40 *0
<br />' b - ,
<br />2 , -'
<br />; - c
<br />1-7• .
<br />.- , -
<br />n0
<br />N tz .,-''
<br />"-- - s. -..... - .--
<br />& :: ..-•-
<br />i I
<br />-
<br />...
<br />t'..t, '".
<br />ft t. o it,,
<br />t...,,. pew*. ,. :
<br />-, :'..., -, -e
<br />; • -..,
<br />..,. 'o...
<br />fE SI.` ii -
<br />• '
<br />'44)70
<br />— 0
<br />,,, * .....
<br />. . **CI***
<br />" -
<br />'“=;:,.
<br />- :
<br />1 inile
<br />NC Z
<br />iki frAl T 14
<br />I: A L
<br />1
<br />- '• i''..
<br />.1 -"-• --MEASUREMENT.
<br />i-.; .-• , .
<br />CT
<br />• • '...' 0, i
<br />, .
<br />. -
<br />SAMPLE ‘
<br />L
<br />-"''' 0 -:, ...
<br />- .• •
<br />. " , i , C . ....,..
<br />• . --,
<br />--" & .•;' 7:
<br />:) ..
<br />). 4 . I
<br />lir
<br />., ,...:.. t. .-• E.:: ,
<br />r t.v • r
<br />: •
<br />.
<br />i
<br />- •
<br />A) '-'
<br />... ':
<br />.
<br />... _
<br />_.
<br />'
<br />ii ' ''' - ,... , ,
<br />PER . ., .
<br />ouniEmEprr2, .
<br />- -1c, . ... t,
<br />, 21
<br />"
<br />:..., _,
<br />:-3,: i4 ;' 1
<br />I .4 i.4 11 • ;
<br />;,;-;' .---' `1
<br />‘.
<br />.1.
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER •
<br />I CERTIFY uNO€R PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED
<br />AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED
<br />ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION
<br />IS TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIG-
<br />NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING
<br />THE POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S C. I 1001 AND
<br />33 U.B.C. 411 13•0). (Penalties under these statutes may Include fmes up to J10,000
<br />and or mazhnurn imprisonment of between 6 months and 5 years.)
<br />_ _ -• - -
<br />.. .... . ,,,. **, -:
<br />c ....), c. 14... ,...; -p -1
<br />:'
<br />.• .., • i44... i _1.
<br />q_
<br />• TELEPHONE
<br />DATE
<br />t - -„
<br />f-- .),, ...cc_
<br />/4...1(. tItilr 11011 41.141i/..t
<br />. ,. .
<br />-..,.- ' , --
<br />, *.1
<br />I I "e' 1 -
<br />I . 4-,3 14.
<br />•-••
<br />..„
<br />..7.!
<br />L
<br />- •
<br />-.. ,
<br />- :
<br />. <
<br />12 - : 5 - 2 53
<br />/‘,/.:
<br />1{:
<br />",\"
<br />SIGNATURE OF PRINCIPAL ECUTIVE
<br />- OFFICER OR AUTHORIZED AGENT
<br />•••• • TYPED OR PRINTED
<br />--....-........- ---.....-.-... -- ........-. ._._.-
<br />ARE
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />PERMITTEE NAMEI S (Include I "
<br />Fonlity Name/ Locatio .nt)
<br />2LAmE E_LA (Arleta 152.91).
<br />A99_ Cl_a 1_11
<br />_
<br />3 ^ •
<br />•
<br />FACILITY
<br />LOCATION 0
<br />f. Dr:NETS STEVE
<br />N5 PRESIflERT
<br />EPA Form 3320.1 (Rev. 9 Previous editions may be used
<br />NATIONAL POLLUTA -HARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHAI NITOR NG REPORT (DMR)
<br />(2-16 (17-19)
<br />P NUMBER ";
<br />+.1
<br />•-■
<br />• • - YEA
<br />FROM j
<br />20-21
<br />MO
<br />Oi
<br />22-23
<br />24-25 ' 2 I
<br />(REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.)
<br />007 A
<br />DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />DAY 1 r YEAR MO DAY
<br />QL T9 • 91 C.)) 30
<br />Npproved.
<br />lo. 2040-0004
<br />F - FINAL Approval expires 6-30-91
<br />STORMWATEI DISCHARGE
<br />F-:
<br />I
<br />:-.
<br />R 1 I
<br />NOR (SJUER 'WC) ItINTRS
<br />NOTE: Read instructions before comDletinu this form.
<br />(R eferenc*ailattachmentrhere )
<br />IF NO"DISC4ARGE OCCURS 3EPORT OIL AND GREASE; SEE FOOTNOrE F/.
<br />L
<br />0005C/900810-1
<br />PAGE OF
<br />
|