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A 1DRE3% L 1 <br /> � - 1 T ; ,Qr - PER '40ER OIlCHAMGI NVMs(p <br /> Z <br /> ----=------------------- MONITORING PERIOD <br /> f��41TY--------------------- YEAR MO OAY [M�� DAY <br /> LN — FROM .;C, I „ TO <br /> OCATIO ,r . <br /> ----- �—�.--•---------- - � <br /> (20.21) (22.23) (24- 1) (26 ) (28-29) (30.31) NOTE: Reed Instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (I Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46-.13) (Sidi) (38.43) (I6.j3) (14-61) NO, FREQUENCY 9AMPLI <br /> OF <br /> (32.37) EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-6J) (61-68) (69-70) <br /> SAMPLE <br /> FLJ (EFFLUE , T) MEASUREMENT 0.033 0.047 0 1/30 CT <br /> PERMIT G <br /> REQUIREMENT 1/30C <br /> SAMPLE 1'•I� • TLIT�i_ $(,gF1 MEASUREMENT * * * +t * * * * 0 22.67 46 0 1/30 GR <br /> (EFFLL'Ell'T) rcRMrT L3 'D r,G/L <br /> S 3 REQUIREMENT * * * * YI * * * * Al Tt * 5 70 11130 G <br /> SAMPLE /� <br /> r,en�r • TOTAL MEASUREMENT ,k * * 0.25 0.36 0.48- 0 1/30 OR <br /> L PERMIT l.H :�G/L <br /> REQUIREMENT * 3.5 ! 7 / 1) G <br /> SAMPLE <br /> Pr4,FIEL,) MEARUREMENT * * * i r i * * 7.80 * * * * 8.20 0 1/30 GR <br /> PERMIT REQUIREMENT * * tt yr yl * * 6.5 * +� * 960 Su 11/30 GR <br /> SAMPLE <br /> f� {/ <br /> OIL 6. G,*.E A A MEASUREMENT * '� i * r< # * * 0 0 0 0 1/30 t 1 <br /> VI9u;L PERMIT MG/L <br /> A L,,I Z REQUIREMENT * * * ,� ,� * * * * * * * * * * 1(y 1/30 Y <br /> SAMPLE <br /> r 1.'JCTI'dITY 61/,.;P MEASUREMENT <br /> * * * t * * *, * 3050 3110 3190 0 1/30 6R <br /> 7 )4., REQUIREMENT �r * * * ,� * * * * ,� * ,� * * ;� ,� •* * * it90 GQ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQU I REM MIr <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> ANO AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> Jay Mednick ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> OBTAINING THE INFORMATION 1 BELIEVE THE SUBMITTED INFORMATION <br /> IS TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG <br /> Hydrogeologist NWCANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDNG 3 337-5903 86 104 25 <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SEE IB USC 1 1001 AND BIGNAT RE OF PRINCIPAL EXEC IVE <br /> D3 USC 11319 /Prnalrlre under rArw erarulee mar Include timer up to $101XMI <br /> TYPED OR PRINTED end wmanmum lmpnwr.nlrnr a/Mluwn6mnnrAr and.5 reenl - OFFICER OR AUTHORIZED AG NT A NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reterence all attachments here) CODE <br /> IF ` IiCIi +MuE CCCLPREI: I:URI -G Tr,16 REPh; TI -�G PE;IC'' REOGRT Ir"C L)ISCr-AKGEII <br /> 1 � <br /> EPA Form 3320.1 (Rev. 10-79)PREVIOUS <br /> EDITION <br /> Is 'TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />