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PERMITTLE -,ADDRESS (include NATIONAL POI I 7 1TISI nAITGr VI I M I N A I W ti',YSTE M 1.�P S) form Approved <br /> hacluyNarnej it ofdi1jerent) DISCH MONITORING RCPORT i1111k/ OMB No.2040-0004 <br /> Nwsime_111 ,e-i.LiN Y I bLL14LL-UA-L_Ti---LPL_ L L - -- - --1- I i---- --- I ` ,f^!1-1 9)- -_�I - — FINAL Approval expires9-30-85 <br /> S L L,I •1 <UK=10Y KZ4HR <br /> —�rL,[7 E IE, L PERMIT NUMBER OISCM ARGE NVMOER J <br /> �.tJ.L7l <br /> MONITORING PERIOD <br /> FACILITY - - --"- --- ---"-" <br /> --------------------- YEAR MO DAY Y-AR MO DAY <br /> LOCATION ------,-----_ FROM 2 �0 <br /> 7 TO MINUK <br /> (20.21) (22-23) (24-25) (2t,-27) (28.29) _PT to NOTE: Read instructions before completing this form. <br /> (3 Card Onl)) QUANTITY OR LOADING (41Card0nly) QUALITY OR CONCENTRATION NO rR[oVEncv SAMPLE <br /> PARAMETER (4653) (54-61) (3845) <br /> (32-37) _— _ (46-53) 15461) or <br /> >< EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64-68) (69.70) <br /> PI L�f SAMPLE ` ** <br /> MEASUREMENT <br /> 00w00 1 0 PERMIT ** * *x�* * *x: 0.5 ****** 9.0 N EEKLYG kA 5 <br /> C REQUIREMENT <br /> SOLIDS, St_1 `ILEABLL SAMPLE sOc�c�QuQE 70C 7a JOc**7(( ` �Y70C 7C <br /> r� MEASUREMENT ,t,y, (� /► 1,, ��II t (� <br /> 0054� 1 0 PERMIT *** ** ' **�k** - **#*�i * REPORT 0.5 0 E� G AS <br /> EFFLLI REQUIREMENT <br /> OIL AND GREASE SAMPLE <br /> FREW I=XTk--GRAV MtTI MEASUREMENT --T <br /> 005!;6 1 0 PERMIT RrrHORT 10 WEEKLY AB <br /> REQUIREMENT <br /> FLU^j IN L,0NUU 11 C1K SAMPLE <br /> THRU TRLA IIMtNI FLANI MEASUREMENT — —^ - <br /> 50050 1 0 PERMIT EPUKT REPURT ******T ****** ****** * ** Yt EKLYI STAN <br /> REQUIREMENT TNSI MX MG 1) <br /> ** <br /> SOLIDS 9 1 UTAL SAMPLE <br /> DISSOLVLLI (MG/L ) MEASUREMENT -- -- <br /> 70295 1 0 PERMIT ***�** #****�x ** ***#** KENUkl REPORT Q RLY G A8 <br /> -v 1-, LSN VALJIL REQUIREMENT - _ �_- * �g <br /> OIL AND GREASE SAMPLE **** ***x** *** ** * <br /> VISUaL MEASUREMENT T[— �C +jE <br /> 84066 1 0 PERMIT RE:POK1 ** Yr --S1 # * * * *** ** * * * WEEKLYV SUAL <br /> REQUIREMENT <br /> 1 LY-M -=-0 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER P —LTY oP LAw TNAT I NAv[ .-R.— III E MIN[D TELEPHONE D A T E <br /> MILDIwR w TN — INFORM An.N SUBMIT T HD N[R.IN wrvDwewaED <br /> m � (L�'? �� No <br /> DMrA INo uIRr INP..mATI INDIV IDu IK IMM E wTELr REa„I N O L[ FDR ♦ /♦ <br /> FtV//O h� BTwININ MqT N I BI LIH VH THE 19u EMITTED INPONM ATION U/1 <br /> ,` / r1 <br /> S TRDT, A(,CURq t1 AND COM PL[T H. 1 AM A ARH TNwT T HR[ ARH /10- <br /> gLT1[[ FOR SUR MITTINO FA LS[ INP ORMAt I. <br /> IN_ <br /> TNHI—1.1BILITY OF PIN[ AND IMPRISONM[rvT, 111 IE V.S.C. 6 —, A U / <br /> oo u.s.c. I I,Io. 11'cnall,es undlrthese Statutes may include fines up to$10,000 SIGNATURE OF PRINCIPAL EX CUTIVE / <br /> TYrED OR PRINTED and,ur Ina Y ununl onpr,sonment ofhehveen 6 months and S years) OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> _ CODE <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Rejerence ail auachmrntshere)IF IVJ UIS-HAKGL [ILLURS ).L"NL;KT "Nu DI:,t,riARGE" FL(.'W 1 : MEASS,AS HGG=M1LL1UN GNLLCNS PER DAY- <br /> 2 P R/,M I-Ll k 06G. <br /> EPA Form 3320-11 (Rev. 10-79) Pf7EVIOUS EDITION 11) NL III;[ D (w PI,ACFS EPA f C INI T 40 WIII�H IlAY NOT BL USLU.I- PAGE Or <br /> UNTIL SUPPLY IS EXHAUSTED, Oo,b b0luo LCB L'CD-152 7 1 <br />