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PERM ITTEE ErADDRESS (Include NATIONAL POLL T DISCHARGE ELIMINATION SYSTEM(NPDES) <br /> FaeduyNan;r1Lo.wtot;lfdlfferenr; DISCH a sE MONITORING REPORT tDAIR) <br /> tMz— ZSU- -A ('-16) (17-191 F - FINAI. <br /> Auane*s P -Q 00039136 -A TOTAL DISCHARGE FACILITY <br /> PERMIT NUMBER DISCHARGE NVMBER <br /> ----_�1��✓`1�1,�\A�� ---- — � — MONITORING PERIOD <br /> FACILITY YEAR I MO I DAY YEAR MO DAY <br /> LOCATION FROM TO 1INOR PITKN <br /> A TT DO U G L A S W RO M M A N — (20-21) (22 23) (24 25) (z6-27) (28.291 (30-31) NOTE: Read instructions before completing this form. <br /> (? Card Onh) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46-53) (54-61) (38-45) (46-53) (5461) NO. FR EOOUF S SAMPLE TYPE <br /> >< EX ANALYSIS TY <br /> (32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> .y .A. ..yA (6163) (6468) (69-70) <br /> III A..•.I•.b A. #YYY Y•� YYYY'r` <br /> PH SAMPLE Y+`YYY <br /> MEASUREMENT <br /> 00400 1 0 0 PERMIT ##*M## #r## 6.5 9.0 WEEKL GRAB <br /> EFFLUENT CROSS VALUeEQUIREMENT #'�## 114 1 N I U M MAXIM M Su <br /> SOLIDS, TOTAL SAMPLE YYYPY• �YYM# #Y�i Y <br /> SUS1:ENDED MEASUREMENT <br /> 00530 1 0 0 PERMIT ^� �~ #Y#### #M# YY WEPORT REPORT ONCE/ GRA$ <br /> EFFLUENT GROSS VALO EQSUREMENT .�# <br /> IJA* 30Dk AV DAILY NJ MG/L MOvTf - <br /> SOLIDS, S ETTLEABLF- SAMPLE <br /> //11 <br /> MEASUREMENT <br /> 00545 1 0 0 PERMIT #Y# #. ##r##- # #Y ###### OPTIONAL REPORT ONCE/ GRAB <br /> EFFLUENT GROSS VkLULPEQUIREMENT # /Iyy <br /> OIL AND GREASE SAMPLE <br /> FREON EXTR-GRAY MET 44EASUREMENT <br /> 00556 1 0 0 PERMIT #vr### ##### #### ###### OPTIONAL 10 VERKL GRAB <br /> EFFLUENT GROSS VALO LREQVIRE.KNT ### DAILY INST My mn/L <br /> IRO`, TOTAL SAMPLE # ### #Y ##### <br /> (A✓ FE) MEASUREMENT <br /> 01045 1 0 0 PERMIT # #### ###### ### ###### REPORT REPORT ONCE/ GRAB <br /> EFFLUENT GROSS VALt EQuIREMENT v### A <br /> FLOW, IN CONDUIT OR SAMPLE YY�vY' �`r#' vv #'�# �► <br /> THRU TREATMENT PLAN EASUREMENT -- — <br /> 50050 1 0 0 PERMIT DEPORT REPORT ###'¢## ###### ###### #### REEKL INSTA <br /> EFFLUENT GROSS V U EgUIREMHNT A e-D #### <br /> SOLIDS, TOTAL SAMPLE <br /> DISSOLVED (MG/L) MEASUREMENT <br /> 70295 1 0 0 PERMIT ##;tom# ###### #Y# ###### REPORT REPORT QTRLI GRAB <br /> EF <br /> F S V U E�QUIREMENT #### 90DA AT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED i <br /> �� �� ON My INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY ED INFIBLEORMATION <br /> FOR <br /> OBTAINING 1HE INFORMATION ORMATIO�V I BELIEVE THE SUBMITTED INFORMATION <br /> IS THIF ACCURATE AND CDMPI ETE I AM AWARE THAT THERE ARE SIG `��,�'�•(7J`(� (/}�J��(/Y� <br /> THE PYT PENALTIES FOR SUBMITTING FA SEINFORMATION INCLUDING 7 / <br /> THE PO��ti191L Ili OF FINE ANtr IMPRISONMENT SEE 10 USC 4 IOpI AND <br /> 33 USL S 1319 /—ah— undue Ihr•.e Awful- rr uulmie (Ine, up hr SMraxr SIGNATURE OF PRINCIPAL ECUTIVE <br /> TYPED OR PRINTED •Ll err 11-11-m unpn.on nu•n1 rrl hl1 eln 6 month,and i van I OFFICER OR AUTHORIZED AGENT CODE AREA NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (ROcrerne all anlrehrnent, here) <br /> IF t'O DISCHARG9 OCCURS REPORT NO DISCHARGE ON YOUR DMR. OIL 6 CREASE NOW 2 PARAM. NO SHEEN: 84066=0, <br /> 556=0, A SHEEN: 84066==11, 556==`GRRAB. SALINITY MEAS. AS TDS. TSS,SETT.SOL, 6 IRON NO LIMIT PREPRINTED ON <br /> 0-1 EP7�'Frl 33� iR r. 0-7 UNTI L SUPPLY IS EXHAUSTED. <br /> ort REPLACES EPA FORM T-40 WHICH MAY NOT BE USEII I <br /> () PAGE OF <br /> 0113/120207-1359 1 <br />