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PERMITIEF 4/ADDRESS (Include NATIONAI POL ITOItitIIAN(,I II11nINnnnN•.vSllnll,\/'/)/$/ form Approved <br /> FacdrtyNarne. ion ifdillcrent) DISCH E MONITORING RLPOHT rowo OMB No.2040-0004 <br /> Nr+MB— I11—Ui1nLI Lfl1E[�lL -Ct1AL L LLA1,L- CU _ r-' 1t11 _ _-. Il7lvI F — FINAL Approval expires 9-30-85 <br /> ADpRE95}�11X t - <br /> _1�-tL------- SECT 8 <UR=10YK24HR <br /> t PERMIT NUMBER DIscH ARCL NUMDER <br /> _— —————___1rt3—Y11 ——_ <br /> _____j--- <br /> -------------- ---- MONITORING PCRIOD <br /> FACILITY— --- <br /> ---------------- YEAR MO DAV YEAR MO UAY <br /> LOCATION FROM TO <br /> -------------------- ti 12 U 1 tsts 1 1 MINOR <br /> (20 21J (22.23) (24 25) (26 27) (28.29) (3031) NOTE: Read instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Onh) QUALITY OR CONCENTRATION <br /> 46-53 FREQUENCY <br /> PARAMETER ( J (54.6/J (384.5/ /4653/ (54.61J NO. of SAMPLE <br /> (32-37) EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM <br /> yy UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64-68) (69-70) <br /> PH SAMPLE <br /> ry/� MEASUREMENT .y y y. {,/ �+�[ p <br /> 00400 1 0 PERMIT *M*�Q** F****T **** Ej�� * * •0 /{ Gf�LYG t7 , <br /> -e, REQUIREMENT <br /> SOLID.),, SETTLEABLE SAMPLE *7Q <br /> MEASUREMENT <br /> 00545 1 0 PERMIT ,��, , _ ,�,�#, ,� **,� 44 REPORT 0.5 0 E/ GAB <br /> REQUIREMENT <br /> 1,, _ <br /> OIL AND GREASE SAMPLE �pc;c�c*�gclQc aKA�***�It <br /> rFREON EXTi.—GRAV MLT MEASUREMENT (,� r^�(�•�• <br /> 0056)6 1 0 PERMIT �#«�CT* ** * ****** `\L l'�K ! 10 K KLYG A6 <br /> r1 /�� /� '1 `� REQUIREMENT . * IIAT yy <br /> FLOWS IN CONDUI 1 OR SAMPLE *** * ***** ***M <br /> THRU TREATMENT PLAN MEASUREMENT <br /> 50050 1 0 PERMIT R 1 REPORT *** * ****** ****** * ** N EKLYI STAN <br /> REQUIREMENT <br /> SOLIDS , TOTAL SAMPLE <br /> DISSOLVED (MULL ) MEASUREMENT -- <br /> 70295 1 0 PERMIT REPORT REPORT Q RLY G AS <br /> REQUIREMENT �`�r-� <br /> OIL ANU GkEASE SAMPLE <br /> VISUAL MEASUREMENT <br /> 8406t> 1 0 PERMIT RL-PURT ****** YES=1 **** * ** *** ****** * ** N EKLYY SUAL <br /> REQUIREMENT <br /> x_ _ *** <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICS"TIFT I DE JNALTY OF LAW THAT I HAVE FERSONw IIY E TELEPHONE D A T E <br /> AND M PA NLIAR WIT <br /> E INFORMATION SUBMITTED HEREIN w D BASOD <br /> ON MY INOM RY OFIiH109E INDIVIDUALS IMMEDIATELY RES ONSrIBIE AFOR N <br /> vot�tN /� /}}•\`� R� OBTAININOF HE INFORMATION, I BELIEVE THE EUBMITTFDFINFORMATION <br /> /V E A1;5 L, If T , A T•'URATE AND -1-STE. 1 M AWARE THAT T ERE INS SID- <br /> E UE wLTOII. FORT SUtl MITTIN. A H IN CL VDInD <br /> c TnE _..,_,Ty <br /> oss B 1— FINE AND IM FRIso NMENT`may <br /> efines g .o$ AND SIGNATURE OF PRINCIPAL EXECUTIVE <br /> g Inls. Iprnalnrsundrr these statutes may Include flnerup to$/0,000 <br /> TYPED OR PRINTED andlor maxi",.nL imprl ion men t of hrhw•en 6 nton thr and 5 years/ OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> _ CODE <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> IF NO U1S(:41AkGE OCCURS I%EPUKT "tuJ UISCHAKGE" ON YUUK UMR.FLUW IS MEAS .AS MGLr=MILLIQN GALLONS PER DAY. <br /> SALINITY MLAS.AS TUS=70295. <br /> EPA Form 3320.1 (Rev. 10-79) PREVIOUS EDITION TO RE U'.LD (REPLALES EPA FORM T-40 WHICH MAY NOT BE USED I [} y C PAGI 1 OF <br /> UNTIL SUPPLY IS EXHAUSTED. 008 L III UL•L B 8b-15 27 1 <br />