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PERMITTEE NAME/ADDRESS (Include Facilirv NamelLxarion iJDi$erenq <br />NAME <br />BLUE= MOUNTAIN f-:NERGY, ING. <br />ADDRESSilESERADO h1INE <br />3667 COUNTY ROAD 65 <br />FACILITYP A'JGL ,' ~"'~ 31 v l;i <br />LOCATION <br />crr:d Irrr nl tnnc~ur <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESI Form ApprOVed. <br />DISCHARGE MONITORING REPORT (DMR) QMB NO. 2040-0004 <br />M I r.J C? R <br />PERMIT NUMBER DISCHARGE NUMBER F_ - ~ I. Nri1. itBl AN <br />MONITORING PERIOD ,`t ~+-t LI]AiiCJVI"" TIJ Rt:D idA~iH <br />YEAR MO DAY YEAR MO DAY _ <br />FROM n ~ TO i 7 #~= iaL D78!:HAkt:;F I ~I ##-# <br />NOTE: Read Instructions befor€CtSmpleting this form. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br /> EX OF TYPE <br />PARAMETER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /+N~-ySls <br />.0:_ !'FORM, FECAL. SAMPLE ###### ;r##K## ;t+tttn;t;t 1,,) <br />:Ef~IERHI_ MEASUREMENT <br />a,~,'i • ~ o AERMIr -rr~F+f~r ,;~t~~lr~'..+r #~ ir~r*~r~~w OOU 000 N ~ CEt- RA1~ <br />:FF . UFN [ GR055 VALVE E1~QUtREM~NT. . ° , ;' ~ ;; r `.' - #it>< '-..` t <br />II. AI"~1I? GREASE SAMPLE ###### 94) ###### ###-##a .#e r~#- <br />t I `~ lei; MEASUREMENT <br />94CGL, I O O .-~ P~l`i` - "i" - ' a N", -, """'`~"' S '1 lF~k~~AF-p. - *#iE~1iNV a c# ? W .tKtµ IS3UAL. <br />Fc i Ut f*I r GR~S5 VALUE p.EQUIREMENT ### ;- <br /> SAMPLE <br /> MEASUREMENT <br /> '' <br /> R6QUIR~M~NT 'i` t °, <br /> SAMPLE <br /> MEASUREMENT <br /> ' ~ J PERMIT . " .. .- - . ~' ' <br /> REQUIEi~M~NT , <br />.e ~r ~ r <br /> SAMPLE <br />' MEASUREMENT <br /> `tFERM('8-~. ~ <br />- <br />- <br />- ~- <br />° " <br />°- <br /> RI:OUIRENIENT - - _ '~ = - - <br /> SAMPLE <br /> MEAS <br />U <br />REMENT ' <br /> ~ <br />p <br />y. pi.rIMIT ] k'r ~~ 1 <br />r <br />~ SL <br />r' ~Y~..L <br />~ .: _ary'5'4Y ~ ~ F ~'I :~ <br /> Rt=bUIREMEN7 . t <br />': '}" <br />: °a - <br /> ~.. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> REQOIREMENT' =~J_ ~ _ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I Ceniy under panelry of law that this tlocument and au anachments were <br />i <br />i <br />i <br />h <br />t <br />i <br />d <br />di <br />i <br />i <br />d <br />tl <br />tl TELEPHONE DATE <br /> under my <br />on or superv <br />n accor <br />ance w <br />em <br />gne <br />prepare <br />rect <br />s <br />on <br />t <br />a sys <br />as <br />j <br />Y~ ~~ <br />} L <br />~ to asaura lhaz qualified personnel properly gather end evaluate the inronnetion - ?~-, <br />~ J <br />G rt <br />EYL subminetl. Based on my inquiry of Ne pereon or persons who marege the system, <br />or those persons tliraclly responsible far gamedng the inlonnatlon <br />the inloimation ' ~~ <br />~ <br />. <br />i <br />( <br />C , <br />aubmmetl ls <br />to the best of m <br />knowletl <br />e and bevel <br />accurate <br />end com <br />lete <br />bue ` <br />~ <br />~,.., <br />• , <br />p <br />. <br />y <br />g <br />, <br />, <br />. <br />i <br />i <br />iN <br />l <br />k <br />li <br />l <br />m <br />f <br />l <br />b <br />b <br />i <br />l SIGNATURE OF PRINCIPAL EXECUTIVE <br />~ <br />~ ~i _.r./. <br />L-,. ~iY ~'2-- <br />YPED PRINTED et mere are s <br />gn~ <br />r su <br />n <br />orma <br />arneware <br />cant pena <br />t <br />es <br />m <br />ng <br />a <br />e <br />on, OFFICER OR AUTHORIZED AGENT NUMBER <br /> <br />T <br />indutlln me ossibdi of bne end Im dsonment for knovn violations. <br />p YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />C'[L E~. GREASE REPORTIN9-SEE ? B 1 f, PG Vli. +3RfF1Lt SAI`tF'~ IPJ'., INCifI<UC'TJ..in'.-( r ~"t; s <br />EPA Form 3320-1 (REV 3/99) Previous editions may be used. THIS IS A 4-PART FORM PAGE OF <br />