Laserfiche WebLink
PERMIT'ILL I ADDRESS (/Allude NAIIUNn11-01 It Ill.IllnNc.11 Formllpproved <br /> FacilityNalnel ..liontfdtf)Lrent/ DISCH -E MONITORING REPORT (DA111 OMB No.2040-0004 <br /> «rM B-1y113=CsLhi11ALL1I— IIAL_-L_L L E—G U __L2jL6j_ _1y�-1� F — FINAL /approval expires 9-30-85 <br /> SL(,T 11 PKECIP .<OR=10YR24HR <br /> PERMIT NUMBER olscN 101E NUMOER <br /> -------------------- MONITORING PERIOD <br /> FACILITY YEAR MO DAY J��fffDAV <br /> -------------------- <br /> LOCATION FROM TO YEAR ,; M1NaR <br /> ------------------ <br /> I (20.21) (22-23) (24-25) (26-27) (28-29) (30-31) NOTE: Read instructions beforecompletinp this form. <br /> (3CardOist) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER ♦w[oucncY <br /> (•JG ill (54-611 (3R45) (46-s3/ (54611 NO. or SAMPLE <br /> (3237) EX wllwLv[Is TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (ALYK (l/69��-70) <br /> PH SAMPLE D �/\ A V� <br /> MEASUREMENT / <br /> 00400 1 0 PERMIT *#* ** *## * * * b�5 #* 9,0 WEEKLYGkAS <br /> C, REQUIREMENT * <br /> 4 <br /> SOLIOSs, SETTLEABLE SAMPLE <br /> MEASUREMENT O/ y.,� [ / O((�� �'•�� p <br /> 00545 1 0 PERMIT Jpc7oC*apt* >!ca(:*>pc�c�c ** * ** # REPURT - 0e5 0 E/ AS <br /> E FF LUENT REQUIREMENT —`-- <br /> OIL/�AND GREASE SAMPLE •* * #* * < / O \ 1.0 <br /> © �' <br /> FREON EXTk—GRAV M'l MEASUREMENT - -�— ` I \\ <br /> 005 5b 1 0 PERMIT * > * **##* x #***** kE PORT 10 W EEKLYG FtAB <br /> REQUIREMENTE-EFL ' <br /> DENT GRUSS VArLC.f1 2 '�'� — MXy_ <br /> FLOW, IN CONDUIT ,U,1i-�.� SAMPLE O � v TA/ <br /> THRU TREATMENT PLAN MEASUREMENT — 7 ` — T ,J�` —T <br /> 50050 1 0 PERMIT REPURTT REPORT ***# * ##*** *## * *# W EKLYI STAN <br /> /� /1 <br /> REQUIREMENT <br /> SO L IDS , TUT AL L SAMPLE QT �� <br /> DISSOLVEU (MU/L ) MEASUREMENT — — �_—(�• �N(`+ <br /> 70295 1 0 PERMIT ****#* ******`*#x� ***�a** REPORT REPORT Q RLY GRAB <br /> REQUIREMENT I — ��(71C10[ �UUAAV MG/L <br /> OIL A14D GREASE SAMPLE 1 # *'�* '�'��`�*# *�"�'�'� '�"p"p"p`#'�; © wK '/7' <br /> VISUAL MEASUREMENT \ ��O - fT <br /> 84066 1 0 PERMIT K LPORT I ##** * ES=1 W EKLYV SUAL <br /> REQUIREMENT qp��yy <br /> _M;(- <br /> SAMPLE <br /> MEASUREMENT <br /> t• <br /> PERMIT <br /> REQUIREMENT , <br /> i <br /> CERTIFY UNDER PENAL fY OF LAW THAT I HAVE PERSONALLY EXAMINED �,/C//►/�� <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I F N TELEPHONE D A T E <br /> AND AM wMILtAR WITH 1ME INFORMATION SUBMITTED HERlIN A D BASiD III(/v//�/C//►�(//// <br /> ��\OJ' �jPI1 �, ON MY INO UIRY IOF THOSE IN OIVIDUAL9 IMMEDIATELY RESFO NSIB LE FOR {FI <br /> VN 'lYj V(��/ OBTAINING THE N OAR MDATION, 1 BELIE Vc THE SUBMITTED IN FO RM AT:ON <br /> IS TRUE ACCURATE C MFLETE. 1 AM AWAKE THAT THERE ARE O <br /> I NIF IC wNT FE NA LTIS9 POR SUBMITTING FALSE IN FORSM ATION IN CLVDI- <br /> P h rHE Fos S'DlL oP Fl"E AND IMPRISONMENT. SEE u.S.c. § lool A- <br /> THE OF PRINCIPAL EXECUTIVE <br /> __ v u.s.c• § I—. (1,names under these statules may include Jules up to$10,000 <br /> TVt CD OR PRINTED and/nr ma vlmnn trnprisomnent of between 6 months and 5 years) OFFICER OR AUTHORIZED AGENT AREA CODE NUMBER YEAR Mo DAY <br /> COMMENT AND E<PLANATION OF ANY VIOLATIONS welerence all attachmrntsllcre) <br /> IF NIJ DISCHARGE OCCUKS KEPLmT '"NU UISCHAKGLO .FLOW IS MEAS.AS MGb=MILLIUN GALLONS PER UAY. <br /> SAL114LIlY MtAS .AS TC/S=70L95 M6/L. 2 PRAM FUR U&G NU SHEEN:84066=UIr556=0jA SHELN: 84U66=1s556= GRAB SAMPLE. <br /> EPA Form 33201 (Rev. 10 79) PREVIOUS Ef)IT ION T J BE USED IREPLACES LPA FORM T-40 WHICH MAY NOT BE USED.) v`! �] UL PAGE OF <br /> UNTIL SUPPLY IS EXHAUSTED. UOO U O/ 08 26 86-15 2 7 1 <br />