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PERMITTEE NAME/ADDRESS pe~y„ee Fanxry l/oaulcararon!/Dtge.v,r) <br />NAME <br />dLUE !S 7UNTATt+ ENER;,Y, IN~. <br />ADDRESSOFSF.RA00 '!INE <br />d6U7.:0UNTY flOAD 6S <br />FACWTY kAN::LY ~ CO !?Ib4!! <br />LOCATION <br />ni'TN: JEFF DGBBEH7 <br />PARAMETER <br />LL ANi) GFEdSP. SAMPLE <br />I.ciU AL MEASUREMENT <br />IJUbu 1 0 0 <br />FE'LUE~T CRO55 YALU <br />SAMPLE <br />SAMPLE <br />AVERAGE <br />NATIONAL POLLIfTAM DISCHARGE EUMINATON SYSTEMlNPDES) <br />DISCHARGE MONRORING REPORT (DMR) <br />FROM <br />Y OR LOADING <br />MAXIMUM U : <br />7 <br />Eti=1 <br />NO=~ <br />NUMBER <br />AVERAGE <br />~: r}:}:f :.~ <br />:. r::t:: {: ;: <br />4# <br />#kC: <br />NAMERI7LE PRINCIPAL EXECUTNE OFFICER I Cerny under penalty d law Nat this document end all ettachmerHS were <br />d <br />i TELEPHON E' DATE <br />under my tlirection or supervis <br />on b accordance with a system tlasignetl <br />C ~~ prepare <br />V1 b aware Nat qudiaed pereonnel prepedy gaNer:arttl evaluate the Fbnmllon <br />6ubmilted. Based on ny Inquiry of the person or persons who meneW ~ eysmm, <br />a tlwca Dareoru tllrectly respmsible br gathering Ne inlormeaon <br />Ne inbnnatlm ~ <br />'' <br />, <br />E~ ~, r ~t submitted b, to the best of my knowledge entl ballet, true, accurate, end complete. <br />SIGNATURE OF PRINCIPAL EXECLfTIVE <br />7Q / <br />p7.S~3 <br />U' / <br />7 <br />TYPED OR PRINTED I em aware that there era signalcent penalties br submitting false Inbrmetion, <br />:__,...:__.._____:.:::.._..____.:________~~..__.:__.,_:_.:___ <br />OFFICER OR AUTHORIZED AGENT <br />____ <br />nlltugca. <br />vr:na <br />ann <br />nnv <br />f:i5 + TOTAL IkOd LI7fITS HILL b2 MRIY'cC, 4t;G SETTLF.APLE SOLIDS LT~I' P.PPLIfD F7:: C=lOYP,,24NB FHECZP EVEl~T- <br />SEE I.R.2, PG Y, FOk RF;~UIRE:i1ENT5. )IL G GuFASP RE?ORTIt:G-SEE I. b. i. F, !'G VII. vi;TkLY SAMPLING <br />3 ~ Aravl6us a ltio way ba used. THIS I 4-PART FORM .PAGE OF <br />' _ _.__00585/D00717~g 2 <br />Fonn Approved. ~ <br />OMB No. 2040-0004 <br />"IPA? <br />(SU3P. Nii) <br />FI&AL RBLAN <br />RA-5 LOAJOI)T TO RFC MASH <br />t:#0 "~ DISCHARGE IKI ~"•`~` <br />NOTE: Read Instructions before~ompleting this form. <br />ONCENTRATION NO. FREOUENC SAMPLE <br />EX of TYPE <br />MAXIMUM UNITS aulrsls <br />