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r! •I+,.I� r rnLrAUDRtss j/ncludc <br /> PERMITTEE NAME/ADDRESS (hiclude NATIONAL POI I LITANY CIISI'IIARGE LI IMINATION yVSTEM t\TIMS) form Approved <br /> FacllltyJVameJLocartl-nlfdifferent) DISCHARGE MONITORING REPORT Il1t1/0 OMB <br /> �2�-�16O 17-19 �' — FINAL Approval expires -85 <br /> ADDREYsw__ .�_—_—_--- ___ SI0.S1.i_9�� SLOT, 17 EFFECT AT ALL TIMES <br /> C A kh i Nuf1A! I- _—__--- CL H 1 62j_— ��LRMIT NUUMB�—ER JJ oISCNARCE N1 M 1 <br /> -------------------- MONITORING PERIOD <br /> IACILITY YEAR MO DAY YEAR MO DAY <br /> LOCATION -----------_`--__ FROM 8 ) o f TO L L MINOR <br /> _ (20-21) (22-23) (24-25) (26.27) (28.29) (30-311 NOTE: Read instructions before completing this form. <br /> (3 Card On I r) QUANTA Y OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46 S_) (54.61) (38-45) (46-53) (54-61) NO. FREQUENCYOF <br /> SAMPLE <br /> (3.371 >< EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63) (64-68) (69-70) <br /> PH SAMPLE * •Ja 7�[7a J� *]�*JK* 74C J`C'.a 7� <br /> MEASUREMENT <br /> 00400 1 0 PERMIT ! ****** ***#* #*** 6.5 ** 900 w EEKLYG A$ <br /> REQUIREMENT #* <br /> MAXIMUM C.1,11 <br /> SOLIDS9 TIJTAL SAMPLE <br /> SUS PENUEU MEASUREMENT — <br /> 005.30 1 0 PERMIT 5 70 0 E/ GRAB <br /> REQUIREMENT * aQQA AV <br /> OIL AND GRLASL SAMPLE <br /> FKEU4 EXTK-GK,AV MLT MEASUREMENT y y y� y ,Iw y <br /> OV55V 1 0 PERMIT *ry 7 **T 7'TIle 4** **7T*T REPOKT 10 W =EKLYG tAB <br /> REQUIREMENT - <br /> IRON, 1U1AL SAMPLE <br /> y' <br /> (AS rL MEASUREMENT - - <br /> 01045 1 0 PERMIT ** ,****** �* ***�** 1.0 2*0 0 E/ GRAB <br /> _ -Gkf,C <br /> US 7 V REQUIREMENT <br /> FLUW11 IN LONUU 1T OR SAMPLE IK ### * *IK * Ik**tK * <br /> THRU TKEATMENI PLANE MEASU REM ENT <br /> 50050 1 0 PERMIT REPORT REPORT ****** ****** ****** * ** W EKLYI14STAN <br /> I` REQUIREMENT <br /> SOLIDS, TOTAL SAMPLE ***** ***** * * * <br /> DISSOLVED (MG/L) MEASUREMENT — — <br /> 70295 1 0 PERMIT *****� ***## *** ****** REPORT REPORT QTRLY G AS <br /> /` (C <br /> REQUIREMENT <br /> OIL AND CREASE SAMPLE <br /> VISUAL MEASUREMENT <br /> 84066 1 0 PERMIT RLPORT ****** tS=I W EKLYV SUAL <br /> EF—LUENT GRIFIS REQUIREMENT NO <br /> _ * * <br /> 1 ERTIFY UNDER PEN.LTv Or LAW THAT 1 HAVH PF_REO rvA LLv E <br /> N AM ErTIT LE PRINCIPAL EXECUTIVE OFFICER xA MInEI TELEPHONE D A T E <br /> D AM rAMILIAR WITH THC INrOR MATION fVEM ITTED HEREIN AnD EA1ED <br /> ��� � � OIN MY INS II IRY of THDEE INDIVIDV IKVE I. <br /> EDI ATELITEEP ON ORM FIN <br /> erwlNlNo rHE IrvFORMwnoN, 1 EKLIaYa THE EUKMIrtEo NFORMAnon REIV <br /> I. TAUS, ACC TK A D COMPLETE. I AWARK THATTHERE ARK SIG- <br /> NIFICANT IENALTIEI FOR f1—MITTING FALSK I I.—T-H, INCLUDING <br /> THE PO snail lTV OF FInE AND IMPg190NMENT. SEE 1S u..c. § 1o.I A.D SIGNATURE OF PRINCIPAL EXECUTIVE <br /> at u.E.c. g 1 un. jPcnalnes under these statutes may Include jmes up to$1 QUUU <br /> T`PED OR PRINTED andlor ma.Lrmum imprisonment of between 6 tnondcs and 5 ycrosl OFFICER OR AUTHORIZED AGENT AREAJ CODE NUMBER I YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS lReference all attachmentshere) <br /> IF NO DISCHARGL UCCURS REPUkT "NO LISLHRGL" ON YJUR DMR .FLOW IS MEAS.AS MGU=MILLION GALLONS PER DAY. <br /> SALINITY MLA*-' * AS TJS=70295 MG/L. 2 PRAM FUR' O&G NU SHEEN :8400b=0.556=0,rA SH L LN :8406b=1 q 55b=GRAB SAMPLE. <br />