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PERMITTEE NAME/ADDRESS (/scrrdePacirrrylJsme/tecarioa yDff,.a,q <br />NAME <br />bLUE i1UUtiTAI.t ttii:h.GY, It:~. <br />ADDRESSDESERADO !".INti <br />ibU7 COUNTY ROAD f;S <br />FACILIn RANGLY ~ ~~ CD~ B1L~9 <br />LOCATION <br />ATfA: ]~FP GU d~SCHT <br />OU. <br />PARAMETER <br />'AVERAGE <br />.'L ANA GRF.AS;. SAMPLE ~ =r='' <br />I S U A L MEASUREMENT <br />UU66 1 v U <br />:FFLUEVT CdJ55 VALUC x <br />SAMPLE <br />SAMPLE <br />~• MEASUREMI <br />SAMPLE <br />~ SAMPLE <br />SAMPLE <br />SAMPLE <br />NATgNAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDESJ Form Approved. <br />DISCHARGE MONITORING REPORT (DMA) OMB No. 2040-0004 <br />. T , <br />^ ~ PERMIT NUMBE DISCHARGE NUMBER (-' ~~ .I ~` N ~ ~ <br />F - 1'INAL psL~\~ <br />MONITORING PERIOD R?-S SEDI POND TO RED idA.~ri; <br />O DAY YEAR MO DAY ' <br />FROM U5 O1 TO U1 ~' 1~i `~4Aead ss rl uc~loos'~befo~6CRhtpletingh is torm. <br />Y OR LO ~ QUANTITY OR CONCENTRATION NO. PREODENC SAMPLE <br />EX oP nPE <br />""""" "' """'' ~" ~`41NIMUM AVERAGE NITS ANALYSIS <br />4400418 t+#C-"-; <br />"rl <br />~_~ <br />MAXIMUM U <br />~: x~r.y~rr <br />nor <br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER ICatiry under penelry dlaw that Nis donxnent antl aN attachmede were TELEPHONE DATE <br />~J.J.~ prepared untler Rry tlkection or superNSlpn M eccortlance wills a system dealgnetl <br />LU r/ Hs to assure d~quekfietl pereonnd properly pother end evaluate NB Mormatlon +1' <br />aubmMted. Eased on my MgtAry d theperson a pernms who manepe the system. _. . <br />h /, CJ? or those perecm tlMSC9Y responsible tar palherirg the Monretlm, Me Inbrmason 1 <br />submitted le , to the best d my know7adge qld belles, true, starers, end complete. SIGNATURE OF PRINCIPAL EXECUTIVE / 7D G7 ~Y ~ ( G 7 ~ ~° <br />TYPED OR PRINTED rem aware that there ere slgnslram penaltlRs for subrttidinp lasso inbrmstion, OFFICER OR AUTHORI~D AGENT NUM9ER YEAR MO DAY <br />Inclutlin the slblli d @» and im Isonrtlerlt br knowin Nolarione. <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relevance ell attachments Aere) <br />'('» ~ TOTAL I:'.09 LICITS '+LLL BE wAIYED, AND SETTLEABLE SOLIDS LIKIT APPLLD FC)~ <=l0YR,24BA.PRECIP F'VF'NT- <br />5EE L A.l, PG Y, FOd Rt;~UIREMEYTS. 7IL 6 GREASE HF'PGPTIYG-c,EE I.H.1.F, I~; VII. ,)H.TRLY SAf1PLING <br />orm 93 3 ) Pr vfous itions say be used. THI ART FORM PAGE OF <br />00597/000717 2 <br />--~-- -_.uy~:~.~__-_ <br />