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PERMITTEE NAME/ADDRESS (Include Fanliry NmnNLomn'on ifDrgerenr) <br />NAME HLUE C.OUAITAIN rASR ;T, IN~a <br />ADDRESSDESP.P.ADU MIM1? <br />160! ~JUMYY HDAG hS <br />FACILITY RARGLY CD tl164R <br />LOCATION <br />APTN: JEFF DUByF.4T <br />C <br />PARAMETER <br />AVERAGE <br />O I L AND G R E A S c SAMPLE '!"''~ ``' <br />YI:iUAL <br />B1Ubb 1 U U <br />2FFLUE~IY GHOSS YALU <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />MEASUREMI <br />SAMPLE <br />SAMPLE <br />NATIONAL POLLUTANT DISCHARGE EUMINATON SYSTEM (NPDESJ Form Approved. <br />DISCHARGE MONITORING REPORT (OMR) OMB NO. 2040-0004 <br />.".I'vJR <br />(SfJBR FY) <br />PERMITNUMBER DISCHARGENUMeER P - FINAL 4HLAA <br />MON110RINQPERIdb~~ ~±'% SLOT ~TOHAGC TO 9ED WASH <br />Y DA `'~ ~ R MO DAY <br />FROM PTO b 1;+4 ND DISCHARGE ~~~ ;~r~ <br />wY NOTE: Read Instructions before completing this form. <br />Y OR LOADING ~ QUANTITY OR CONCENTRATION NO.. FREOUENC SAMPLE <br />EX of TYPE <br />MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS aNUt51s <br />FS=1 - <br />NO=O <br />O <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICertay under penalty allaw that this docupient and e4 eaachmema were <br />r <br />M <br />tli <br />ll <br />tl <br />i <br />d <br />M <br />tl <br />l <br />tl <br />N <br />i EPHONE DATE <br /> p <br />epare <br />er my <br />rec <br />on or supet <br />u <br />on <br />n ecar <br />erce w <br />a system <br />ee <br />gne <br />S <br />~ ~ <br /> O Q y)S <br />W meura thal quaYfied persorerel properly gather and evtllrete Ne iMormation ' <br />~ <br /> eubmkted. rased on my klgtrlry ofNq person or pemons who merege the aystem, • <br /> T or Noae penom dkeClY reePonebb ka gethering the Inlormatlon, the Inbrmation <br />y <br />b <br />kt <br />d l <br />b th <br />b <br />f <br />k <br />l <br />d b <br />li <br />f <br />d <br />l p-~ ' <br /> t eu <br />m <br />e <br />a , <br />e <br />est o <br />my <br />now <br />etlge en <br />e <br />e <br />, rue, accurate, en <br />comp <br />ete. <br />l <br />o <br />l <br />lA <br />lu <br />f <br />i <br />i <br />h <br />i <br />tl SIGNATURE OF PRINCIPAL EXECUTIVE I r ~ ~ Q ~ G7 Z G <br /> TVPED am aware <br />tet r <br />ars ere e <br />gn <br />Cant pena <br />or aubm <br />ng <br />ake <br />ea <br />d <br />nbrmadon, <br />PRINTED <br />Includin the wslbil' of ahe endi risomnent br knavln vlolaaone. OFFICER OR AUTHORN:ED AGENT <br />NUMB <br />Y R <br />MO <br />DAY <br />COMMENTS D EXPLANATION~OF ANY VIOLATIONS (Reference ell attachments here) <br />TSS 5 TDTAL IRON LI^IITS 7I LL F„' IrAIYEU, ANG SETTLfA9LE SJLIDS LI"IIT AFFLI£C FOR <=lOYR,Z4RR PAF.CTP F.VF.NT- <br />5°E I. A.2, PG V, FOR RE2UI RStSENTS. JIL GREASE REPORtI N'J-3EC' I. U.1. F. FG YII. J3TkLY SAMPLTII (: <br />be useQ. IS I PART FORM PAGE OF <br />eo6l~iooo7i~'-i~3$_ _ z <br />