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PERMffTEE NAME/ADDRESS (Inelude Facility Name/Locatlon IJDigoenq <br />NAME BLUE l90UNTAII: csEFt ;T, Ih~, <br />ADDRESSDESERADO MIN£ <br />iti07 COUNTY ROAD 5] <br />h.ANGLY CO 41649 <br />FACILITY <br />LOCATION <br />.7IN: JEFF DUBBERT <br />PARAMETER <br />P B SAMPLE <br /> MEASUREMI <br />UULLUO 1 U 1 <br />EF'FLUE'NT GROSS VAL'J ~. <br />SOLIDS, TOTAL SAMPLE <br />SUSPENDED MEASUREMI <br />UU]!U 1 0 U <br />E.F'F'LUEkT GRDSS YALU <br />SJLID°, s~rateABLe SAMPLE <br /> MEASUREMI <br />uu5u] 1 0 ;C <br />EFFLUENT GR YALU <br />OIL GREASE'::' SAMPLE <br /> MEASUREMI <br />UU]]b I 0 0 <br />EeF'LUENT GRO S YALU <br />IICJN, TOTAL SAMPLE <br />(A S F E) MEASUREMI <br />JiJ4] 1 0 .Q <br />k.Ff'LUENT GROSS PALU <br />FLOii, IN CONDUIT OR SAMPLE <br />1':IRU THEATISENT PLAN MEASUREMI <br />]UU]U 1 0 0 <br />cF'ELUENT GP.OSS YALU <br />SOLIDS, TDTAL SAMPLE <br />as I I ua:~+,.,r~: <br />U L S S O L V E D MEASUREMENT <br />lUl9] 1 U U era <br />tf'FLUENT GROSS YALU =f~h ~'=I. -.~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICeniy uMer penalty Blew ttw this tlocumententl ep ebechmenLS were <br />~~yy prepared under my tlirection or suparviaan kt accordance wtth a system tlesigned <br />S^ D / / N s ~~ b assure NM quallAetl perwnnel properlygether end evaluate the inbrmation <br />lr I I submitted. 6eced m my InquMy d the perean or persona who managetha system, <br />F or Inose persons drsdhy rssporwible for gatherkg the IMOrma[lon, the iMormmion <br />~~ submMetl Is , to Ne beat d my knowletl~ end bel b, bue, eauret b~complete. SIGNATURE OF PRINCIPAL EXECUTVE <br />( 19) <br />( 2 `--' ) <br />( 19) <br />( 14) <br />( 19) <br />DATE <br />TYPE I em aware Nat there are sign ¢eM pen t <br />es or su mittmg a se In on, <br />RPRINTED Inclutlin the sibil' drtne end lm rlsonment for krwwin violations. OFFICER OR AUTHORIZED AGENT ~ AREA NUMBER YEAR MO DAY <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence ell attachments here) I <br />;55 6 TOTAL IRON LI'7IT5 aILL BE ~AIVc,U, 3tiL SP::TLeA,°L.°. SDhIGS LIriI' APPLIiLD FOR <=10YR,24RR PRECIP °_Y'.:NT- <br />Sh'd I.A.1, PC Y, FOR kE,~UIRE!!F.NTS. .OIL ~ GRFAS% Ra'POrT.LN;-St8 I. 5. 1.?, PG VII. ~F.TRLT 5AC!PLING <br /> <br />0 3 ~, dr l~us a Itions rosy be used. -PART FORM PAGE <br />S <br />I ~4 <br />_ _ _ ,-~T -II OF ~ <br /> D 0 ~,$ a / ~ <br />i <br />Q i <br />1 <br />AVERAGE <br />Oo i <br />NATIONAL POLLIfTAHT DISCHARGE ELIMINATION SYSTEM MPDES) Forth ApprOVed. <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040-0004 <br />'1I'tOh <br />(SU:3N AV) I <br />RMIT NUMBER DISCHARGE NUMBER F_ FINAL H B L A N <br />FROM <br />' MONITO LNG PERIOD <br />YEAR 0 .DA ~ YEAR MO DAY <br /> 0' J1 ~~1; 30 <br />RA-1 LOADOUT' ?D AF.D NASH <br />°:t:s NO OISCiIARGE ~ y~ t"x~ <br />NOTE: Read InsVUCtions betore'L`Nlllpleting this form. <br />! OR LOADING QUANTITY OR CONCENTRATION NO. FflEOUENC SAMPL <br />EX of TYPE <br />MAXIMUM UNITS ~ MINIMUM AVERAGE MAXIMUM UNITS ANUrs/s <br />a+aar,aa a4r~rc.•ti (. ll) <br />C::r <br />Q~FOn <br />kOat <br />( ~~~ ~ rxat+: ~ :x+x:xt:tra ~ atr~:xa.A <br />