Laserfiche WebLink
PCOMITTFE F/ADDRCSS (Include NATIONAI P01 I F nP,r HAN(.I W SJ form Approved <br /> Facl:uyNanle). ion lfili f,rent) DISCHt E MONITORING REPORT 4-1110 OMB No.2040-0004 <br /> ++rLM g_ MZU-(_LLy T i N Et�l l—_CLIA L -L- (-LAI L- G U I�--'� 1{t11 -_ _ _-- (/7 l''/ F — FI TVA L Approval expires 9-30-85 <br /> —LUP k1a Lh�-9AtBER OISCMARGENIIMOLN SELT 8 <UR=10YR24HR <br /> -- RMIT NUM <br /> ----- CH <br /> MONITORING-- � <br /> -------------- — --- MONITORING PERIOD <br /> FACILITY----------------- YEAR MO DAV YEAR MO DAV <br /> LOCATION FROMATTNf MINOR <br /> 1 _ (20-21) (22.23) (24-2sf /a<7J I28-2vJ /30-31) NOTE: Read instructions before completing this form. <br /> 1`3 Card Orth) QUANTITY OR LOADING (4 Card Oniv) QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> PARAMETER (46-53) (54.61) (38-45) 146.5.1) (54-61) or <br /> (32.37) >< EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62.63 (64-68) (69-70) <br /> PH SAMPLE 7�C�c :�C7pC 7� �;J�? '1�7�C * 7QC 78C 74C <br /> MEASUREMENT <br /> 00400 1 0 PERMIT *#*##* *## # *** 6e5 —* *** .0 W EKLYG SE-EFl , <br /> 1 REQUIREMENT ' <br /> .MINIMUM(-2 <br /> _ I <br /> SOLIDS, SETTLEABLE SAMPLE JQC70C>OcIOc>Ic>Oc Ik�k#�k** *# <br /> MEASUREMENT <br /> OU545 1 0 PERMIT , �clpD4c #Ix#*** ## — REPORT 0.5 0 CE/ GAB <br /> REQUIREMENT <br /> OIL AND GKEEASL SAMPLE <br /> FREON EXTk—GRAV MLTH <br /> MEASUREMENT <br /> 00556 1 0 PERMIT ##,�#�F# #* # ��� **�*�# KEPOKT 10 W KLYG AS <br /> EEE <br /> _ REQUIREMENT <br /> ** <br /> FLOW, IN CONDUIT OR SAMPLE *** * #*# * * <br /> THRU TREATMENT PLAN MEASUREMENT <br /> 50050 1 0 PERMIT R REPORT ****** ****** ****** * ** Ili EKLYI STAN <br /> REQUIREMENT <br /> SOLIDS , TOTAL SAMPLE �6 # ** <br /> UISSOLVED (MU/L ) MEASUREMENT <br /> 70295 1 G PERMIT ** #** # �pc**# **gyp*** REPORT REPORT Q LY G AS <br /> '=NT r , REQUIREMENT ## AV <br /> OIL AMU G KEASE SAMPLE **** * ***IK** *** ]*[FIR *** ** <br /> VISUAL MEASUREMENT <br /> 84066 1 0 PERMIT RLPORT #***** Yr_S-1 W EKLYY SUAL <br /> REQUIREMENT _ <br /> F F F L11,r_NT I; 0A I LY -MX-- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER IT NO <br /> R I wLrHYE INFORMATION <br /> LAW THAT I H • TELEPHONE D A T E <br /> I IORMATION SUBMITTED HEREIN Y AND w BASED <br /> NGUI RY OrT OSE INDIV IpU ALf IMMEp1ATELY RESPONSIBLE FOR <br /> nEN :`HERINFO DTIOM•IEBELIEVE HE fVB1"A T,INPOA.AT;oN � 1� <br /> Al U ATE AN f L TE. 1 AMTA WARE TN AT TI iRE <br /> ANT EnwLTIE4 FOR SVBMITTINO PALE IPORMwTION INCLUDING <br /> " POS1319 OF PInit wrvn IMPRISONMENT.hese es SEE l efines 4 loal ANp SIGNATURE OF PRINCIPAL EXECUTIVE <br /> U.S.C.s.e. 4 1 ols. (Pena/nrs undtr these statutes may include fines up to$10,000 <br /> TYP; D OR PRINTED and11)r ma xunum impnv,nmrnt of hrh oren 6 months and 5)cars) OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAV <br /> CODE <br /> COMMEN r AND EXPLANATION OF ANY VIOLATIONS (Reference all attaeh/nents here) <br /> IF NO U1S(-IiAkGE: OCCURS KEPUKT ENO UISGHlkKGE11 ON YUUR UMR.FLUW IS MEAS .AS MGL=MILLICIN GALLONS PER DAY. <br /> SAL114ITY Mt-AS.AS TD8=70295. <br /> EPA Form 3323-1 Rev. 10-79) PRE VIRUS EDITInN Tel 13F L S!D 11,I I n ! I PA I047M 1 40 WHICH MA 1 1401 1,1 LISI P 1 PAGt_ CF <br /> UN I IL SUPPLY IS LXIIAUSTLU. (I Oil f 6-15 2 7 1 <br />