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PERMITTEE NAME/ADDRESS pnelude Facifiry Nmnr/Laranon ljDij(ovrt) <br />NAME BLUE YOUNTAI+ th F;dGY, Iti" <br />'°'DDRESSDESEB,ADO PILAF <br />U607 :,OllhTY kOAU 55 <br />FACILITY HRN.GLY ~0 51645 <br />LOCATION <br />RTTN: .)d?F DUHIipNT <br />PARAMETER <br />YISURL <br />HaUbb i U U <br />zFFL'JENS GROSS Y6L <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />AVERAGE <br />NATIONAL POLLIfTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />FROM <br />MAXIMUM UNITS <br />r )ut <br />Form Approved. <br />r lt; OMB NO. 2040-0004 <br />(;USP. 9W) <br />r - FItiAL <br />RP-u SEDI POND TO RED GASH <br />MINIMUM I AVERAGE <br />ES-1 <br />N0=0 <br />~' Read Instructions before completing this form <br />KNLAN <br />'RATION NO. FREOUENC SAMPL <br />EX OF TYPE <br />MAXIMUM UNITS` AIdALYSt9 <br /> <br />A 44d <br />~~~~ .... r~A <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER ICerey under penally of law Net this COCUmem and all edachmerita were <br />d <br />d <br />i TELEPHONE DATE <br />.µ ~ '1~ prepare <br />un <br />er my tl <br />rectlon or eppervieien M accordance wsh a system tleslgnetl <br />SLO// I,{~cc~3 toazsurathatqueXfiedpersonnWpro~nygefherendavaluacetheinromtatim - <br />eubmMed. Bnaetl on my kpuky0tthe or perooru w1w menage the system, <br />or Nme persons tllrectl <br />ros <br />anaQXe fx <br />eNMn <br />the Inrormetion <br />the IMOrmazion <br />y <br />p <br />g <br />, <br />g <br />EI'1 /r ~N eubmMetlh,tothabeetotrnykra..xtlgeentleellel,true,eauraze,entlcomplete. <br />l SIGNATURE OF PRINCIPAL EXECUTIVE quo 67s-y3~z ~i v~ <br />am aware that there areelgNfiWM peneleee for aubmidinq false lnbrmetion, <br />TYPED OR PRINTED <br />Indudinn thw nnsolhllild NGnw anHimnnenrment Mr4mwim Nnlarinne OFFICER OR AUTHORIZED AGENT ~~nr: <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND F>(PLANATION OF ANY VIOLATIONS (Relerence allatf~chments here) <br />I~~S TOTAL IRON Lin ITS uiLL HE JAIY€p, RND 3ETTLt'6RLt: ::L:D:, LIMIT APPLI%C FOk C=l0YR,2++HH PkECIP F.Y2:NT- <br />SEP. L. A. 2, PG V, FOR RE;~UTRF9ENT5. JFL 6 GRF.ASI: RFPO4TI:IC-SEF. I.tt.1.F, PI; VII. pRTP.LY SAMPLING <br />i <br />A orm 2 3 9 nevi Us rtions may be used. TT~~III ART FORM PAGE OF ; <br />00665/000717.z~~ -_-. 2 <br />