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PERMITTE IIE/ADDRESS deft ludo NATIONAL POE LU DISCHARGE ELIMINATION bYSILM I.\/'U/ \) form Approved. <br /> !•aunt) Non otlon I/ diyerenr) DISCHA MONITORING REPORT (O11H) OMB No.2040-0004 <br /> NAME M.LEJ—k,UN_TINtr,T CLAL L LUKE:_L_V _ 11-/6I (17-19) F — FINAL Approval expires9-30-BS <br /> ADDRES88OX 158 C00000396 026 A _ SECT 10 EFFECT AT ALL T1MES <br /> _______ <br /> --- CARbUNUALE -----_—(:0_8_16L3-- PERM+T NUMBER DISCHARGE NUMBER <br /> ———————————————————————— MONITORING PERIOD <br /> EAScILL--------------------- YEAR MO DAY NO <br /> DAY <br /> LOCATION FROM TO MINOR P I T KN <br /> ATTN: UOUGLAS 1JOWMAN t ENV COUKU (20-21) (22-23) (24-25) (z6z7) l:,v 9) �+0-11) NOTE: Read instructions before completing this form. <br /> (3 Card Onl)) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46-33) (54-6/) (3845) (46-33) (54-6 FREQUENCY <br /> 1) NO. OF SAMPLE <br /> (32-37) >< 1 EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (62-63) (64-08) (69-70) <br /> PH SAMPLE <br /> MEASUREMENT <br /> 00400 1 0 PERMIT 6.5 ****** 9,() EEKLY AB <br /> EFFLUENT bROSS VALUE. <br /> REQUIREMENT ***3k MI WI.Mk MAXIMUM SU <br /> SOLIDS,. TOTAL SAMPLE <br /> SUSPENDED MEASUREMENT <br /> 00530 1 0 PERMIT 35 70 NCE/ RAFT <br /> EFFLUENT GROSS VALID REQUIREMENT * 3 M PMONTH <br /> OIL AND GRE..ASL SAMPLE <br /> FREON EXTR—GRAY MET MEASUREMENT <br /> 00556 1 0 PERMIT ****** ** *** ****** OPTIONAL 10 WEEKLY AB <br /> EFFLUENT GROSS YALV REQUIREMENT <br /> INST MX MG/L <br /> IRONt TOTAL` SAMPLE * ** ****** ****** <br /> AS FE ) MEASUREMENT <br /> 01045 1 0 PERMIT * ** ****** *** F ****** 1,0 2e0 NCE/ RAB <br /> EFFLUENT 6RUSS VALU REQUIREMENT * AVMONTH <br /> F LOWt IN LONDU I T OK SAMPLE ****** ****A*L* ****** <br /> ThRU TREATMENT PLANT <br /> MEASUREMENT {� <br /> 50050 1 0 PERMIT REPORT REPURT ****** ****** ****** *** EEKLY ENSTAN <br /> EFFLUENT GRUSS VALU REQUIREMENT ; INST MAI MGU #*** <br /> SOLIDS, TUTAL SAMPLE ****** * * * ****** <br /> DISSOLVED (MV/L) MEASUREMENT <br /> 70295 1! 0 PERMIT ****** ****** *** ** *** REPORT kEPURT TRLY 'RAFT <br /> GR <br /> OSS ROSS VALUt <br /> REQUIREMENT **** <br /> {� <br /> A AV Mu/ <br /> OIL ANU GKEASE SAMPLE ***** ****** ****** ****** <br /> VISUAL MEASUREMENT <br /> 84066 1 0 PERMIT REPORT ****** ES=1 4EEKLY ISUAL <br /> EFFLUENT GROSS VALU dREQUIREMENT DAILY MX1 NO=O **** <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAw THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> T{�f,I �E AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> V '/ " 7/J:� ON My <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR �\ / <br /> T `f/(j OBTAINING THE INFORMATION 1 BELIEVE THE SUBMITTED INFORMATION 70.Jj <br /> IS TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG <br /> NIFICANT PE NALTIE5 FOR SUBMITTING FALSE INFORMATION INCI TIDING (� <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SEE 18 USC 1 1001 AND SIGNATURE OF PRINCIPAL EXECUTIVE a <br /> 33 USF 5 1319 rP—Ine, urulvr thv.r Emtutr. nw1 mrtudr /uu. up I., lIu IMXr <br /> TYPED OR PRINTED arut err mnumwr mrP / D_ / _? <br /> r...... nt�d hrtuvrn 6 mnnth.and �rar`r OFFICER OR AUTHORIZED AGENT A A NUMBER YEAR MCODEO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Relerrrne all attolllmentT here) <br /> IF NO DISCHARGt UCLUkS KEPURT "Nu DISCHARGE"ON YOUR DMR .OEG G PARAM.NO SHE EN:84066=Ot►556=0.A SHEEN:84066= <br /> 1 ),556=GRA B.//SALINITY MEA S.AS TD 5=70295 146/L . <br /> -PA Form 3220.1 (Rev. 10.79)UNTIL BU EDITION IS EXTO BE HAUSTED D (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) QL0L/t/02C�4z7—L 103 PAGE 1 OF <br />