zip code

							                                 FINAL SLUDGE
PAGE 1 OF 2
                        MONITORING REPORT FORM
                    METALS, CYANIDE, AND TOTAL PHENOLS


PERMITTEE NAME:

STREET/P.O. BOX:
CITY
STATE:
ZIP CODE:

PHONE:

COMMENTS:

PERMIT NUMBER: IL                   DIS:    SLU M

REPORTING PERIOD    FROM:                  TO:
Location S = FINAL SLUDGE
PARAMETER NAME              REPORTED CONCENTRATION                 FREQUENCY
STORET & LOCATION                                          UNITS   OF ANALYSIS
                       MINIMUM   AVERAGE         MAXIMUM
ANTIMONY
01098
S
ARSENIC
01003
S
BARIUM
78466
S
BERYLLIUM
01013
S
CADMIUM
78476
S
CHROMIUM (TOT)
78473
S
COPPER
78475
S
CYANIDE
61556
S
IRON (TOT)
78474
S
LEAD
78468
S
MANGANESE
01053
S
MERCURY
78471
S
NICKEL
78469
S
SELENIUM
61518
S
SILVER
01078
S
THALLIUM
34480
S


FINAL SLUDGE – METALS, CYANIDE, AND TOTAL PHENOLS
PAGE 2 OF 2
ZINC
78467
S
PHENOLS (TOT)
32731
S