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PERMITTEE NAME/ADDRESS (lnclyde Faelllry NmnNlocatlon (lDi9ercnQ <br />NAME BLUE "1JlJYTAIN E'•ifi^.Y, I:J~• <br />ADDRESSpFScHADO PILAF. <br />3601 ~OUt,TY kOAC h5 <br />RARELY CO o'1D43 <br />FACILITY <br />LOCATION <br />ATPN: OEY!' DUN_aEHT <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INRDES) FDrm AppTOVed. <br />DISCHARGE MONITORING REPORT (OMR) OMB No. 2040.0004 <br />I, ~~ <br />~I ~ (SiidF. 't Y) <br />PERMIT NUMBER DISCHARGE NUMBER v- F I N A L R 8 L A 9 <br />MONITORING PERIOD RA-2 LOADOIIT TO P.ED HASH <br />YEAR MO OAY YEAR MO DAY <br />FROM TO '~rry hJ DI:if:HARGF ={"~ <br />NOTE: Read Instructions before completing this form. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER EX OF TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rwALYStS <br />AIL AND GREASE. SAMPLE t:#aa#a ( 9~1) #t:##h# ##aaa:y r<r,c,f,,,. <br />Y I S IJ p L MEASUREMENT <br />°f4Dbb I U U $~=1 a4`h "n <br />cF'YLUENT GHO55 VALU NO=U - ~~at - .~`.{`~~ ~•~'' <br /> SAMPLE <br /> MEASUREMENT <br /> {„N } <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ,! <br /> rte" .~ r,.. . <br /> SAMPLE <br /> MEASUREMENT <br /> n <br /> , s. ~ - `«. .mk <br /> SAMPLE <br /> MEASUREMENT <br /> > 3, <br /> SAMPLE <br /> MEASUREMENT <br /> -e p `••. a _, <br /> SAMPLE <br /> MEASUREMENT <br /> ~ <br />NAME/TITLE PRINCIPAL IXECUTIVE OFFICER ICertiy under penalry dlaw martMs gogqment and all adacMnente were TELEPHON DATE <br /> <br />yts prepared under my Wreclion or supervision In exordance with a rystem tlesignetl <br />b~ssure Uret qualiRed paeoreleVprop9dyyathar end evaluala Na idormetlon <br />~' <br /> eubmltted. easetl on my MgiAydfhaperaon or persons who marrage d»Sy~tem, <br /> Iha Inbrmetlon <br />or Noee persons direNy r9apmelble br <br />aNatng the krtonnetion <br />Yl <br />~ll/ , <br />g <br />k <br />7 <br />l <br />l <br />d <br />l <br />M ^~ ~ 1'{ <br />, ,we,eccurete,en <br />now <br />ie <br />oomp <br />ate. <br />aubminetlb,tothebe¢t <br />edgeentlbe <br />gry SIGNATURE OF PRINCIPAL EXECUTIVE 7 <br /> <br />TYPED OR PRINTED lam aware Net there era slQndcaM pehsltles for submlding lalse lnbnnation, <br />Inclutling NepmsibYNVMIRIe end imprisonment tar krawing oblations. OFFICER OR AUTHORIZED AGENT <br />D <br />E NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all'2tl2Chments here) <br />1'SS i TUTAL IHUN LT:'tI TS WILL HE YAIV ~D, AfiD SETTLER C9LF. SOLIDS LICIIT. APPLI'r.D !'"l4 C=IOTA, 24HR PRECIP ';VFK:- <br />5!'E i.A.l, PS V, Put: HF~UIRF.yF,NTS. OIL t, GREASE HF,PORTIN':-SEE. I. 9. 1. F, P~ VI i. viTELgY(~lil-dPLI11G <br />A oRn 2 3 9 revl us Itions may be used. 00 S 69 / 0O 0 717 ~S1S 5 APART FORM PAGE 2 OF <br />