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PERMITTEE E/ADDRESS (Include NATIONAL POLLU' DISCHARGE ELIMINATION SYSTEM I.`•PUI.1) orm Approved <br /> Facility Nam uon rI ddjerent) DISCHAI MONITORING REPORT (1)81R) IMS No.2040-oo04 <br /> NAME_ M1U—C_UNTIN_LNT_C_OAL_F_ CLKE_CU (:-Inl (17-19) F - FINAL APprove/expires 9-30-86 <br /> ADDRESS_b ULX_L 1_5b __—_— 11 8 _= GO0000396 025 SrCT 10 <OR=10YR24HR <br /> CAKblJNUALCL CU1b23 PERMIT NUMBER DISCHARGE NUMBER, <br /> __—__--_------ -------- MONITORING PERIOD <br /> F& LIL____--_—_---_—_---_-- YEAR r—MO DAY C�I AR MO DAY <br /> LOCATION FROM (� TO YE —� M TNOK <br /> AT1N: DOUGLAS ti(JWMANjP ENV LCURD (20.21) (22-23) (24-25) (2627) (829) ()-I-rl) NOTE: Read instructions before completing this form. <br /> (3 Curd Onl)) QUANTITY OR LOADING (4 card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46-53) (54-61) (3845) L46-53) (34-61) NO. FREOOFNCY SAMPLE <br /> >< EX ANALYSIS TYPE <br /> (32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> (62-63) (64-68) (6Y-70) <br /> PH SAMPLEAL*# �II <br /> MEASUREMENT <br /> OU400 1 0 PERMIT 6.5 **** * 9.0 W EEKLV GRAM <br /> EF U NT C-ROSS VALLe <br /> EQUIREMENT *** <br /> SCUDS, SETTLEABLE SAMPLE <br /> MEASUREMENT <br /> 00545 1 0 PERMIT REPURT 0.5 ONCE/ GRAB <br /> EFFLUENT R A REQUIREMENT $�c## <br /> OIL AND GREASE SAMPLE ** * ** <br /> FREON EXTR--GRAY MLT EASU REM ENT <br /> 00556 1 0 PERMIT ** ** ***** * ****** REPORT 10 WEEKL GRAB <br /> EFFLUENT EQUIREMENT <br /> FLOW, 1N CUNUUIT UR SAMPLE * ** ** * * * * <br /> THRU TREATMENT PLAN <br /> MEASUREMENT <br /> 50050 1 0 PERMIT REPORT PORT ****** ****** **** **** W EEKLY INSIA <br /> EFFLUENT GROSS -REQUIREMENT <br /> SOL1U5 , TUTA�IL, SAMPLE <br /> DISSOLVED (MG L ) MEASUREMENT <br /> 70295 1 0 PERMIT * �k1a ****** *** ** ** REPOKT REPORT QTRLY GRAB <br /> EFFLUENT LROSS VALLe EQUIREM ENT <br /> OIL AND GREASE SAMPLE <br /> VISUAL MEASUREMENT 1. ��j E ` <br /> 84066 1 0 PERMIT R b PORT ** ** ES-1 WEEKL VISUA <br /> EFFLUENT EQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY 04DER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> / � �I�l ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RE SPONSIBI F FOR <br /> vlj� ORMATION I BELIEVE <br /> OBTAINING THE INF THE SUBMITTED INFORMATION <br /> IS TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG <br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING <br /> THE POS SIGNATURE OF PRINCIPAL EXECUTIVE <br /> SIBILITY OF FINE AND IMPRISONMENT SEE 16 USC 4 1001 AND / <br /> 33 USr t 1319 1P.nalt— under rhr•.e .randy-. ran. ..,hide /an, up r" tyre raver <br /> TYPED OR PRINTED nn.l,u ma umum rmprr....... r��/M1r lit ern 6 m�lnrh.and r�rnrT i OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS IReleren—all urtachmentL here) <br /> IF NU DISCHARGE UCLURS kEPORT "NU U1SCHAKhE".SALINI1Y SHALL bF- MEAS.AS TUS=70295, MG/L. <br /> OCG NOW 2 PRAM .NU SHLEN:h4U66=0, 55b=0.A SHELN:84066=11556=GRAB SAMPLE . <br /> EFTA Form 3320.1 (Rev. 10-79)PREVIOUS EDITION TO BE USED (REPLACE$ EPA FORM T-40 WHICH MAY NOT BE USED.) UU�J�S�t�lOUbfS[ _1646 PAGE 1 OF <br /> UNTIL SUPPLY 15 EXHAUSTED V <br />