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PERMITTEE NAME/ADDRE$$Qnelode Faciliry Name/Location iJDi$ermq NATIONAL POILUiANT DISCHARGE El1MINATION BY$TEM (NPDESJ Form Appi <br />NAME p1SCHAflGE MONITORING REPORT <br />BLUE "IJUNfAIN 2NE1?,;Y, IH~, ,.; (DMRI OMBNO.20a0- <br />"Ia j: <br />I ADDRESSpESERAUO `LINE <br />l <br />(SURi2 !i N) <br />.1807 COUNTY ROAD bS ~ <br />PER UMBER DI HARGENUMBER p _ FINAL - <br />_ <br />1 HA~IGLY QD::B164d <br />FACILITY MONIf(1 I PERIOD kP-1 SLDI PDND °O RFC NAS.. <br />{ <br />-_ <br />` <br />"'' YEAR -A10 YEAR MO DAY <br />LOCATION <br />FROM TO 1 03 1 X>tA NO DISCHARGE ~d!~ ~t'~~" <br />A T T N: ~ 8r r D U R b E R T NOTE: Read Instructions before plating this form. <br /> '~ ~ UANTITY OR LOADING _ ~ pUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br /> PARAMETER ' EX of TYPE <br /> <br /> AVERAGE MAXIMUM UNITS< IMUM AVERAGE MAXIMUM UNITS '~-~rs <br /> OI'L AND GREASE SAMPLE K`P#P.G ( 9U) ar#c: ;:~, PPP4#R ;:;Fr.rx~ <br /> V I S U A L MEASUREMENT <br /> ti4"Ub6 1 U U ''''FE MI„ ~d ; ~, <br />,~;;~ ES=1 '' #P=* <br />~ <br /> ErfLUE.Nf 6kJSS YALU REQUIREMENT :, <br />, <br />`~e N0=0 ~ ~: P#3f "~^ <br /> SAMPLE ^~ <br /> MEASUREMENT ~ ~ ~ ~I' <br /> <br /> REQUIREI~NT -" ~~ t~ ' <br /> . a ,. <br /> SAMPLE <br />1 , ~" <br /> MEASUREMENT ~'~ ' .. <br /> ,, <br /> <br />` <br />(iEC1U(FIEMENT <br />;' ~'"-'"; <br />t <br />f'^i <br />'~ j <br />{ <br /> ,; r , <br />,,,v <br /> SAMPLE .. <br /> MEASUREMENT <br />; . <br />~~ <br /> Yt° ~ <br /> ~iT{~UIR~7dENT e ,4 s ~~ r ~ { s <br /> SAMPLE ~ ~ ~~ .t <br /> MEASUREMENT <br /> <br /> _~ wY~; b ~,q, • "i <br /> SAMPLE <br /> MEA <br />SUREMENT <br /> <br /> Sy <br />SAMPLE <br />.. ti"r;FRRM p ~~~'`r' }~u~T ¢r±' j~'4~' ~r,~'_ ~ri« '4 <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICeniy under panalrydlawflHt ~40Nmentand all attachments wire TELEPHONE DATE <br />prepared under my direction MSnpB{yfsigil H accordance wlth a system designed <br />SCD~Gr~t y to assure thatqualdietlper;onnefproparlypaRfarand~valuatetheNlonnatlon ~ <br />subm~aed. Based on my 4lgeiry MUtbpxson or persons who manage fha system, ' <br />or those persons dradly rospon3ide~x gAthering the information, the inormatlon ~f/ ~~ ~~ Qr <br />,7 (J, ~r ~Jr' submitted ls,to lha best d(my knowledge and beliel, True, accurate, antl complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br />lam aware>haz theta pia sgnlf¢ant penalties /prsubmining false information, NUMBER YEAR MO DAY <br />TYPED OR PRINTED includi the sib" aFMe endi risonment for knawin violations. OFFICER OR AUTHORIZED AGENT A <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerencg dchments here) ' <br />TSS S TOTAL Ik0!: LI:?-ITS BILL dE rAIYED, AHD SEtTLEAfLE SOLIDS LI9I'f APFLIEa F'JR C=lOTR,24HR PRECiP F.VE.HT- <br />SEF. I.A.2, PG V, FOk REIUIRElfERT~. JIL ~ GREASE k?PORTING-SEE I.B.1.F, PG VII. QR"~~T--IIRLY SAMPLING <br />.} o~rm 3 ~ revlUuse Itionsmaybeused. 00489/00 0717 1k~~0-PART FORM PAGE 2 OF <br />~i'sa dL3 S <br />