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PERMITTEE /ADDRESS (bulude FIAIIUNAI I'M I I [W" IInNOI I I(MINA IIIIN•,Y%11 M(M'111,1) Form Approved <br /> FacdaYA'ame/ unIJdifterent) DISCH L MONITORING REPORT Mlfl?) OMB No.2040-0004 <br /> N A M e _ I j.,jlA L y_�.L�{L_(„-U_.__—__ I �_,-,____L' I rlI L-!°) r — FINAL Approve/expires 9-30-B5 <br /> ADpRES)} _tFis� ---___ SECT. 16 t<OR=10YR24HIR <br /> PERMIT NUMBER orscHARG[NUM BCN <br /> MONITORING PERIOD <br /> FACILITY <br /> M— <br /> FROMMO DAY <br /> LOCATION 8b 1L o7 1� 31 MINOR <br /> V .` ^i NOTE: Read instructions before completing this form. <br /> L'o.l/ /2. '3/ (..4<5/ /26-.t7/ 118.29) /30-31/ p 9 <br /> =A"V'E' <br /> rally QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION NO FREQUENCY SAMPLE <br /> PARAMETER6-53) (.54.61) (3845) (46.53) (54-61) o► <br /> (3`,37) EX ANALYSIS TYPE <br /> RAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64.68) (69-70) <br /> P H SAMPLE Ipc>dc�c J8U'C 7(IC �pc ldl7k7x�c 76[ 7b[ <br /> (� /I�� MEASUREMENT y,t,,�, L (� L{ �I p <br /> 00400 1 0 PERMIT �c 1pc>Oc>3c** * �IK ** 6.5 * *** 7.0 W EKLYG AS <br /> REQUIREMENT <br /> EFFLULN1 GROSS- VALUE <br /> SOLIDS, SETTLL--ABLE SAMPLE 71C*lpcSpc�c�c >fc�c> I�pc <br /> MEASUREMENT 1 <br /> 00545 1 0 PERMIT **** ,� *I1#** **** **** REPORT 0.5 0 CE/ GRAB <br /> _ REQUIREMENT <br /> GROSS 1 <br /> OIL AND GREASE SAMPLE <br /> FRE ON EXTk—(,RAV MET MEASUREMENT <br /> 00556 1 PERMIT REPORT 10 W EKLYG AS <br /> REQUIREMENT DAILY MX. <br /> FLOWII IN CUNWIT, Uk SAMPLE <br /> THRU TREATMENT PLANT MEASUREMENT <br /> 50050 1 0 PERMIT kE R REPUR7 ** * ** W 'EKLYI 57AN <br /> REQUIREMENT <br /> SOLIDS, TOTAL SAMPLE <br /> DISSOLVED (MG/L ) MEASUREMENT I � ` I] <br /> 70295 1 0 PERMIT #7�C##** T *#*#* *** * * * REPORT REPORT Q RLY GRAB <br /> FEEEMENT 1• REQUIREMENT <br /> OIL A{V GRI_ASE: SAMPLE <br /> VISUAL <br /> /� MEASUREMENT �`yy y <br /> 84066 1 0 PERMIT RLPORry **** * YES=1 * *IP** *** * #** * *# W EKLYV SUAL <br /> _ _ REQUIREMENT N /� <br /> L H <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cFRrIFT MIL , I Nw LTT aF L— THAT 1 HAVE FER HER— <br /> EXAMINED TELEPHONE D A T E <br /> ND AM MIL <br /> WITH 'HE <br /> INFORMATION SUBMITT F" HEREIN AHD BASF" <br /> N MV IN RFV OF THOSE INDIVIDUALS IMMCOI STFLY RESF I—O L! FOR F� /�.� <br /> VV/ v OBTAINING INF ORMwT10N, 1 BELIEVE THE UBMITTF" INFO HM ATION 71/�tW�1% <br /> IL T uF, ACCURATE ANO ( 1MFLITF 1 AM AWARE THAT THiRF wR UD{G <br /> AN a L, FDR ��BMITTIND FALSE IHFD'{M�TIDH. IHCoo wN" — 3 <br /> =�-F— THE FOSSI I T TI FINE A IM FRISON M E HT. {!4 .S.C. § 1 <br /> u.{.e, § IJI9. IPerlaltles under these smtutcs may,mcluJc Jules up d/510,U00 SIGNATU RE OF PRINCIPAL EX ECUTIVE <br /> AREAJTYPED OR PRINTED a "0r MdA111aun myvlsonment efhenacen 6 months ands years/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rejerence all attachmentS here) <br /> IF NO UISLHARUtE UCCURS KE-PORT "NO Ul-SCHARGE" SALINITY SHALL BL MEAS.AS TUS+70295 MG/L. <br /> U&G r!JW 2 PRAM .NO SHEEN:840o6=0,556=0 .A SHEEh:8406e=1t55b=GRAB SAMPLE . <br /> EPA Form 33�0.1 (Rev. 10 79) PREVIOU i EDITION TO Ill U'A D (RLPLACES EPA FORM T-40 WHICH MAY NOT Fir USLD.I PAGE OF <br /> UNTILSUPPLY ISEXHAUSTLD. Ulf- f /08k886-1527 1 <br />