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PERMITTEE NAME/ADDRESS (7neludeFanliryName/Locanon ifDi$ervrt)
<br />NAME
<br />bLU'F .".DU':;AI:I EGF,h.GY, ItIC.
<br />ADDRESSD 4 S c~ A J O ~ ~ I ., .,
<br />3601 ~~I7NTY :: CLAD b'~
<br />FACILITY n A F :, L Y ;: p H l b 4 t
<br />LOCATION
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<br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM MPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />Y MO DAY YEAR MO DAY
<br />FROM 0 p5 O1 TO '~] ^5
<br />Form Approved.
<br />OMB No. 2040-0004
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<br />'~ ~~ NOTE: Read Insfruc dns before plating this Corm.
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<br /> QUANTITY OR LOADIN ~ QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER EX of TYPE
<br /> AVERAGE MAXIMUM U MINIMUM AVERAGE MAXIMUM UNITS aNw'>s7s
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<br /> MEASUREMENT
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<br /> MEASUREMENT
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<br />V[ S U A L MEASUREMENT
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<br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER ICertAy under penelry of lawthat this tlocumam entl ell anachments were TELEPHONE DATE
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<br />J L' D / / / (%/ prepared under my direction or supervision in accordance wrth a system tlesigried
<br />to assure that qualified personnel properly gather end evaluate the inlonneGOn
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<br />. eubmrttetl. Bazed on my inquiry of the person or persons who manage Iha system, ~~
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<br />e. SIGNATURE OF PRINCIPAL EXECUTIVE ~~ 7 - NCO fi
<br />TYPE RPRINTED Ism aware that there ore signiACant penalties for eubmining lake inlormaaon.
<br />includin the ossibili of fine end lm risonmant for knowin vlolabons. OFFICER OR AUTHOflIZED AGENT NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />iF NL` JISC`iAPi:L OCCili:~, .....YGT ".tip 7ISCtiA'Gii" JN i7 ". F'. ~~iL °: .;!t2.A~L - -_.. I..l.i. '.;.liAfiTERLT SACPLING
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<br />EPA Form 3320.1 (REV 3/99) Previous editions may be used. THIS IS A 4PART FORM PAGE OF
<br />l)07UL/OOu717-1350 1
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