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Ft"MITIL I IA11UI/1".'i (11h111dr NA111111/,1 1.111 111 III IIA111.1 I1IriNlAllnll pY'.II LI 11/'ll/,11 I ofin Approved <br /> FacilityNarrlcl .on ifdiffirent/ DISCI E MONITORING RLPOR-f I ino OMB No.2040-0004 <br /> sME 1NLNT LEIAI --L- (',(IKE CJ-L__— 2-16 17- etl f- — FINAL Approval expires9-30-85 <br /> II_(13�?� SELT.8 WOK=10Yk24HR <br /> `- PERMIT NUM. DISCHARGE NUMBER <br /> -------------------- MONITORING PERIOD <br /> FACILITY <br /> ---------------------- YEAR MO I DAY YEAR MO DAY <br /> LOCATION ---------- FROM U O 1 O 1 TO (�b 12 <br /> 31 MIN Ip <br /> _ (20--2C71) (22-23) (24-2) (26--27) (288-29) (30-31) NOTE: Read instructions before completing this form. <br /> (3 Card On I I,) QUANTITY OR LOADING (4 Card Onl r) QUALITY OR CONCENTRATION <br /> PARAMETER 5461 (38451 NO. iR EOUENCV SAMPLE <br /> /46 53J /- J /46-,53/ (54-61J of <br /> (32-37/ - ---- -- - EX wnwLYsls TYPE <br /> \ AVERAGE MAXIMUM UNITS MINIMUM AVERAGE <br /> yyyy MAXIMUM UNITS 62-63 (64-68) (69-70) <br /> PH SAMPLET# *# ** #TTT <br /> MEASUREMENT <br /> 00400 1 0 PERMIT *�jc7pcl�CQc **>Dc�p[�c# *�QaQc�c 6.5 9.0 WEEKLYG AB <br /> REQUIREMENT MAXIMUM 11 <br /> SOLIDS, SETTLEABLE SAMPLE JOC*�1�C7`G �c�L 1pc$Ipc 7jC <br /> MEASUREMENT <br /> 00545 1 0 PERMIT R EQVIREMENT REPORT 0.5 U E/ GAB <br /> OIL AND GRLNSE SAMPLE Ip[rpopc�c>dca}c >OL ##�k4;>�# <br /> FREON EXTk--GRAV METH <br /> MEASUREMENT ---- <br /> 005 56 1 U PERMIT >ic>�*►K►K ** * Ik*** * REPORT 10 W EEKLYMAS . <br /> REQUIREMENT <br /> FLOW' IN CONDUIT OR SAMPLE *## ## #***#* #►k*#** <br /> THRU TREATMENT PLANT <br /> MEASUREMENT - <br /> 50050 1 0 PERMIT RE T REPORT W EKLYI STAN <br /> EFFLUENT GROSS VAIIA REQUIREMENT I <br /> SOLIDS q TOTAL SAMPLE >aA[#�r#F * #* * #►V* <br /> DISSOLVED (MG/L ) MEASUREMENT - -- <br /> 70295 1 0 PERMIT #I�#### #**# **# #** # REPORT REPORT U RLY G AB <br /> REQUIREMENT 90DA AV <br /> OIL AND GREASE SAMPLE <br /> VISUAL r� MEASUREMENT - <br /> 84066 1 0 PERMIT R LPURT Y S=1 W EKLYY SUAL <br /> REQUIREMENT D y � �/ <br /> --1ilLl l-L-- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I el _ ENA r OF LAw —« T I «Av! Fr A L1 ! TELEPHONE D A T E <br /> AN AMIIDA WIT« TN! I- M.T10N S MITTlo •f !IN AND B D <br /> oN. N'UIRY R„P TNOSE INDIVIOV ALS IM lDIA IDH MRi f'PONf CLRl wFOR Y \ r •- <br /> fV-\��j-� «! FO TI L e-1aV! r«• ION /J/\_�-//�.• <br /> Nfl T 1U IN A1:CURwTe AND • IT!. 1 FA AWARE RNIA TD«f:R f! wM•TfIG- _ <br /> S FOR 6UBMITTING FALSE IN I N IN <br /> 1UDING <br /> r«il rofsle i rYl of Fmc AND IM•RIsoNMENT, fe• n U.S C. § loos AND <br /> SIGNATURE OF PRINCIPAL EXECUTIVE <br /> )l u.s.e. § —6- I Ip,•r1111ues under these statutes may include lines up in$10,000 <br /> TYPED OR PRINTED and/or maximun11nil,monmU7t ofhewcen 6 months and Sl ears) OFFICER OR AUTHORIZED AGENT AREAJ CODE NUMBER YEAR MO DAY <br /> COMME,IT AND EXPLANATION OF ANY VIOLATIONS (Relerence all allachments there) <br /> IF bJ CI,`�'I.NAR(GL- OCCURS Kcl'UkT 111,40 U1 ,CVll-SKGE" UN YUUR UMR <br /> EPA Folm 3320 1 (Rev. 10 79) PREY IOU i EDITION Tr) 111 11�[:D i17t PI-A(FS EPA FORM T 4^ WH11 H MAY NOI 11[ U`E[T I L PAGE OF <br /> UNTIL SUPPLY IS EXIIAUi1 ED. 0Q9 b L/082686-1527 1 <br />