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PERMITTEI 4F;AODRr-SS (In(lude NATIONAI Pot HT DI'.e'F+ARC.F I I IMINATION SYSTI M(%I'W'S/ form Approved <br /> facility Name II11ifdillerent) DISCF- E MONITORING ncpo I'I' ow/o OMB No.2040-0004 <br /> s rH E M i u—LLLN T I N LbLL(r LA-L,—L--L-LK E_C.-U—_—__ .- t 6 _(1,'-15 1 F — FINAL Approval expires 9-30-85 <br /> _CO 0 00 03 96 S?Q;i-g__ SELT 5 LFFECT AT ALL TIMES <br /> 1 PERMIT NUMBER unuunw NUMDLn <br /> ---LA b-L1 UALF.------�.Li_-3i16G�----- - --- <br /> ------------- -- -- -- -- — MONITORING PERIOD <br /> FACILITY W—OYEAR MO DAY YM DAYLOCATION FROM TO I MINUk <br /> — �' —HOWMA LN IL RE) (20.21) 122-23) (24.25) (26-27) (28-29) (30-31) NOTE: Read instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Oil l') QUALITY OR CONCENTRATION FREQUENCY <br /> PARAMETER (.1( 53) (54.61) (38 4-5) (46.53) (5461) NO. QF SAMPLE <br /> (32.37) —--- EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64-68) (69-70) <br /> PM SAMPLE : # �KTT# VI AIT' # <br /> MEASUREMENT <br /> OU400 1 0 PERMIT ##�� **###* *max# 6.5 - ----#*#* 9.0 MEEKLYG Ab <br /> '�•/�_ GRWSR REQUIREMENT # * <br /> SOLIDS* TOTAL SAMPLE # # # #IK ## <br /> SUSPIENUEU MEASUREMENT 6 �y/� (� <br /> 005 W 1 O PERMIT T* ** # * * # 5 /0 O E/ 6 <br /> Pi—;FLUENTENT GROSS REQUIREMENT r' <br /> OIL AND GkLASE SAMPLE <br /> FKE CN LXTR-GKAV MET t MEASUREMENTIr <br /> — <br /> 00556 1 0 PERMIT h'EPURT 10 WEEKLYGkAS <br /> REQVIREMEFFLUENT GROSS VALOF ENT <br /> IRON, TOTAL SAMPLE <br /> (AS FE ) MEASUREMENT �y <br /> 01045 1 0 PERMIT I # * #* ** # ******— 1.0 2.0 0 E' Ab <br /> REQUIREMEN . .Y <br /> - 3010A <br /> T LO h1i 1N CUN UU IT Vk SAMPLE *# #* * # * # **# <br /> THRU/�TREATME`N,T PLAN MEASUREMEN L ♦I�, <br /> 50050 1 0 PERMIT KEPURT REPORT *#� *#### * T * Mt EKLYI S/TAN <br /> EFFLUENT GROSS VALUF REQUIREMENT <br /> SOL IDS t TO1 AL SAMPLE ' TT TT # * T * <br /> DISSOLVtU' (Nib/L ) MEASUREMENT REPORT <br /> any <br /> 70295 1 0 PERMIT # # # * # #* *** RL PORT REPORT Q LY G AB <br /> REQUIREMENT _ 90DA,,,_AV MG/L <br /> OIL AND GREASE- SAMPLE * 1F # # * * #####* <br /> VISUAL MEASUREMENT (;p ya — ,y y�L.t y L► v c��F��F ggggggjj** <br /> 84066 1 0 PERMIT K LPURT %` YL$_1 T'F** ** *T ## k * #* W EKLYY SV7'R71w <br /> EFFLUENT REQUIREMENT I-Ly-Vf M)( -- Y= — <br /> IVQ_ ### <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cERnrr VNOE Au v Dr LAW THAT I H cRao NAVY E MINED TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THC INFORMATION SUBMITTED HEREIN AND AB ASEO <br /> DR OSE INoIY IDu wLs IMMED--T RESPONSIBLE FOR ^ '^ <br /> ©Nv BTAN.N. THE INFORMATION• 1 BELIEVE THE SUBMITTED I-ORMATION \T1 <br /> "• 1'sEV�7 IS T E, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIO- <br /> ���A.� a!i�Da <br /> NIFIc-ANT PENALTIES FOR BUBMII rlry6 FALSE INFORMATION, IN CLUOINO THE Soc El ......or PINE A 1O +M FwIso LAMENT. AEc I. rJules 4 lo01 AND SIGNATURE OF PRINCIPAL EXECUTIVE <br /> TT � 4 �+a. IP,n,rltlrs undl•r these slaRUrs may rR('luJr Jules up to$10,000 <br /> TYPED OR PRINTED and/or maslrr 11n1/•nsonn1, It,,/hrtlreu16 mnn lhs and 51,ars) OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> _ CODE <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rejerence all attachments here) <br /> IF NO UIS:.FtARGE OCCURS KEP(I :f "NO UISCHAKGLO ON YOUR UMk.FLVW IS MEAS .AS MGU=MILLION GALLONS PER DAY. <br /> SALINITY <br /> y� -MtAS.AS TL5=7Ut9 I 5. PRAM FUG: UEG NU SHEEN: 8406=0 9 5 56=C A SHE E-N:84066=1 P556=GRAB SAMPLE* <br /> :3 � PREVIOUS EDITION TO RE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 11 PAGE OF <br /> v UNTIL SUPPLY IS EXHAUSTED. 001 70/OU 21;86-1527 1 <br />