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PE14MIl ILI I iAUDIt1:SS IInlhilk NATIONAI IN)I ITCH", IIAIIbI I I IMIr-IA III]N•.Y',Il r.l�\/'/r/„\) Form Approved <br /> FacdiryNaine, Ion rfdifftren1) DISCI E MONITORING REPORT ,IittR) OMB No.2040-0004 <br /> E^M E_-. :—('I� j 11 C-(1 D l .-_C ---- —-- — - I--/n LI 7-l ILL_ F — FINAL Approval expires 9-30-85 <br /> ADDRESsbI Ix 1 56 ------__—_—______— •OO 00 113 96 1j ,)LLT 10 <OR=10YR24HR <br /> y � PERMIT NUMBER DISCHARGE NUMBER <br /> ------------ — — — ------- MONITORING PERIOD <br /> IrACI LITY <br /> --------------------- YEAR MO DAV YEAR MO I DAY e� <br /> LOCATION FROM D` 1 L U 1 TO f3 ti 12 31 MINOR <br /> NOR <br /> --------------------- <br /> rlL (20-21) (22-2/ (14.25) (26-27) /28-�9) (300-31) NOTE: Read instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION NO. <br /> O FREQUENCY SAMPLE <br /> PARAMETER (4653) (5461) (384i/ (46-53) (54-61) or <br /> (32-37) >< EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 62-63 (64-68) (69-70) <br /> P LJ SAMPLE 7�7Q 7oC 7�.�I Q �[;,L 7�C7�[ c J6C Tat 7�c Jo-JOc70[ <br /> MEASUREMENT <br /> 00400 1 0 PERMIT lac lac Ja:1a Jac ac tanaT lacaa t Jar*# x 6.5 9,0 N E K LY G Bi <br /> REQUIREMENT <br /> 1" <br /> SULlu. . I S:TTL`ABLL SAMPLE ,Fit�p yc�t sac>� # I JpcJa <br /> MEASV R E M E N T <br /> 0054-'.) 1 U PERMIT Ja JacJgcJxJaapt T *,�JxJx,t>ot JatJaJa Ik�kX�#�k REPURT 0.5 0 4C E/ G AB <br /> r I - t' L f`L II REQUIREMENT <br /> OIL ANU GkFASF SAMPLE <br /> MEASUREMENT <br /> FKEUN EXTk—OKAY ML=T 005 -' 6 1 0 PERMIT — RE-r R ( 10 W EKLYG AR <br /> REQUIREMENT <br /> F L O w, IN C u N DIIU I T G K SAMPLE *)aC 7a-7y Jat Ja( 7aC 71C yC 7Q 7�C>� 7aL 7�.ry)pCJaC <br /> THRU TRLATMENT PLANT <br /> MEASUREMENT �y y _ <br /> 500bu 1 0 PERMIT R{ REPORT *# ** ***#* * ** * ** WEEKLY STAKE <br /> REQUIREMENT �����r• <br /> I I r _ -�N.ir� <br /> SOLIDS, TOTAL SAMPLEJSCJat 7aC laCf7aG Ja >aC7} �CIY <br /> UISSOLVL-D (Mb/L MEASUREMENT — _ '-- -- — <br /> 702 9-51 V PERMIT *plc#6t �a aJaL *Ja: JacJp Ja Jpc # * RE PUR7 REPORT Q RLY GRAB <br /> REQUIREMENT <br /> OIL AND GKtASE SAMPLE — TTTT JK #* JxlatJac �Ft/*Ik�k�k #IKIk*IkJk <br /> VISUAL MEASUREMENT — U[�{� y L( { I <br /> 84066 1 0 PERMIT KEPORT ' �'�tJ YES-1 �tJat�t'a"��` # ** W EKLYY SUAL <br /> FEELIREQUIREMENT <br /> E ' CROSS VAIIIE Nrl= <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cl RrIPY UNDER PENA or LAw THAT I HA— PLRiDNALI. ! N!D <br /> w MILIAR WITH T E INFORMATION SUBMITTED HEREIN A MAsiO TELEPHONE D A T E <br /> ND <br /> I INDIV IO UALS IMMEDIATELY RESPONi1BLE POR <br /> TO �'I �,�C%;?3^//�j'\' r{, OBTA AlINDO TH! IN-MATION, 1 BELIH V! TH! 9UBMITTEO INPORRM T. <br /> //i// L �r(/�./ (/ . TRUE, gCCURA TE AND COM IMITE. I AM AWA_TMwT THiR! A ! i1G- �•rW�� E� <br /> A LSE INP ORMATION, IN CLUDIrvG \�/.\j_ <br /> rHi Os c RILIr PLOP rIN ERw ND IMPRI s o N M E N T, — 1. u.i.c. 1 1.$ w00 SIGNATURE OF PRINCI ALE TIVE <br /> „ B 551I I sl., IPcrmluce Iu+dl r there Trun,rvT inav Include fines up to Sl0,000 <br /> ARIA <br /> TYPED OR PRINTED and,lor nravnram unprlsonnnnt of hctlYecn6nl,nt111 and Syears/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (RiJI•rencc all attach ntentslicre) <br /> Ir N1 DISCHARGE UCCUK�p KLPLIKT "Nu UISCHtkUE" SALINITY SHALL LI:. hi AS.A;, TU;,=-t0295 MG/L. <br /> Ot;G NOW 2 NRAIM .NU SHLLN:840oo=0155y=0.A SHELN: 840 66=1 1 5:b=bKAL, SAMPLE . <br /> EPA Form 3320-1 (Rev. 10-79) PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) t- 1 PAGE OF <br /> UNTIL SUPPLY IS EXHAUSTED 0 14 Lk'/Ob 2t--66--1 527 1 <br />