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PERMITTER !/ADDRESS llnlludr NATIONAL POI IUT DISCHARGE ELJMINAIInN SYSTEM orm Approved. <br /> PacnlGry Nr.m uon IJ d11Jerent) DISCHAI tONITORING REPORT" (1/NIR) MB No.2040.0004 <br /> NAME—_M.LD—CUNTINEN1 LUAL tL_ CUKE LU —_ ____I: 1n1 (17-14)_ F — FINAL Approve/expires9-30-8b <br /> ADDRESS t3UX_l5ti _ ) —= GU 4T NUMB 4Z4 SECT 11 �<OK=10YR24HR <br /> CARbONUHLL CU 1f.13 PERMIT NUMBER DISCHARGE NVMBER <br /> ------------------------- MONITORING PERIOD <br /> Fri CILITY--------------------- YEAR MO DAY I YEAR MO DAY <br /> LOCATION FROM TO M I NUR <br /> ATTN-. DUU GLAS 30W MkN LNV C UORD (20-21) (22-23) (24-25) (2627) ( X 29) (+o-rr) NOTE: Read instructions before completing this form. <br /> (J Card Only) QUANTITY OR LOADING 44 (rod On6) QUALITY OR CONCENTRATION <br /> PARAMETER (46-53) (54-61) (3845) (46-53) (54.61) NO. FREOOUFNCY SAMPLE <br /> (3137) >< E% ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM I UNITS (6 EX (64-68) (69-70) <br /> PH SAMPLE * ***#4L 4 *#* <br /> MEASUREMENT <br /> 00400 1 0 PERMIT *##'�** *# *## **# 6.5 ****** 9.0 K EEKL GRAB <br /> EFFLUENT GROSSVALUEREQUIREMENT * * <br /> SOLIDS* SETTLEABLE SAMPLE <br /> MEASUREMENT <br /> 00545 1 0 PERMIT REPORT 0.5 ONCE/ GRAB <br /> LFLUENT -t' REQUIREMENT <br /> OIL AND GREASE SAMPLE * ** *# ** <br /> FREON EXTR VRAV ME EASUREMENT <br /> 00556 1 U PERMIT ** ** *# *** REPORT 10 0 GRAB <br /> EFFLUENT <br /> cT GROSS ,-T EQUIREMENT <br /> U ** <br /> FLOW„ IN CONWIT SAMPLE **#** ***** *#*** <br /> THRU TREATMENT PLAN <br /> EASUREMENT <br /> 50050 1 0 i PERMIT R REPORT ***�* ****** *****� *** WEEKL INSTA <br /> EQUIREMENT <br /> �) INST NX- HGO <br /> SULIOS4 TOTAL SAMPLE # * ** ** * tl <br /> DISSOLVED (Mb/L ) MEASUREMENT <br /> 702v5 1 0 PERMIT REPORT REPORT QTRLY GRAB <br /> E .REQUIREMENT ** <br /> AV— <br /> OIL AND GREASE SAMPLE <br /> VISUAL MEASUREMENT <br /> 840b6 1 0 PERMIT REPORT ****** ES=1 ****** ****** ****** **** EEKL VISUA <br /> EFFLUENT <br /> r T -REQUIREMENT <br /> Cr SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY FXAMINED TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> J©#� OBTAINING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION <br /> 15 TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG <br /> NIF(CANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SEE IS U5C 1 1001 AND SIGNATURE OF PRINCIPAL EXECUTIVE /^�/�—o• <br /> 33 U S C 5 1319 rh-11r. —dr. thr.r .10.1— may uulldr /Inr. up n, tlrr unu <br /> TYPED OR PRINTED ­0 ^"^aumu^'Imp OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (R,-ler(,nl.e all allacllnlrnrc he,e) <br /> IF NU DISGHARGL UCCURS KEPURT "NU UISCHARGE".SALINITY SftALL be MEAS.AS -1 US=70295 MG/L. <br /> O&G NOW 2 PRAM.NU SHLEN:84066=0#55t,=O *A SHEEN:84U66=1 ,556=GKAb SAMPLE, <br /> LP/% I Dim 13320 1 (Rev. 10.79)yR iV`0'�)IL\TI5 ETOAUST USED <br /> (REPLACES EPA FORM T-40 WHICH MAY NOT BE USLD.) 0064£�/100686-1646 PAGE 1 OF <br />