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PERMITTEE NAME/ADDRESS Qnclude Farilirv Name/LOCahon iJDderenq
<br />NAME
<br />BLUE P1JUfrTAIN ~:h::d'~Y, P:".
<br />ADDRESSDESE8AD0 HIKE
<br />sb0) ~outlrY NDAr. b5
<br />FACILLTY dANG~,f CO~~dlb43
<br />LOCATION
<br />AfPN: JEFF DU.'E3T
<br />:ai~tii.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR}
<br />_ r,
<br />`• r' T NUMBER DI GE RUMBER
<br />MOl1 RING PER'
<br />Y R MO DAY .,Pr YEAR MO DAY
<br />FROM O 1 4 O O 1 r; ti 3 0
<br />Form Approved.
<br />OMB No. 2040-1X)04
<br />`'INOt;
<br />{ali '3 ii NW)
<br />-r' - FINAL RULAN
<br />~P-1 SP:GI PON^ ?0 N6'D YASd
<br />NOTE: Read Instructions befor9'LR11Tfpletinp this form..
<br /> QUANTITY OR LOADING ~ OUANTITY OR CONCENTRATION NO. AREOUENC 'SAMPLE
<br />PARAMETER EX of TYPE
<br /> AVEft46~, MAXIMUM U MINIMUM ~ AVERAGE MAXIMUM UNITS aNtd.r5/S
<br />'`i SAMPLE 40 q:XO't '}:% ... ( ~'I
<br /> MEASUREMENT ~ <~ "~jt;~ ~ -.
<br />UyJJ 1 J 1 ;.~?fi`RNI1Ti -~~ .vrka #a r~5 ~"S~~E:: .
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<br />r F L'J E r+'T G N 05 S Y A L U E ~EOUIREM~NT ""
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<br />-OLiJS, TOTAL SAMPLE - ••~ 4a#OpDR. #a.^rt#* {
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<br />JiiPBN3ED MEASUREMENT ,
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<br />tJLIDS, SETTL2AdL:: SAMPLE #a c•.a<:^~ ..,-cc;ea•. { ~5)
<br /> MEASUREMENT
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<br />,:Ff'LUENT GROSS YAL IF REGt!lIREMENT #r.. ,„,
<br />IL !; aR°ASB SAMPLE .r,: :;::~ ¢##
<br />~ : . .. .. ::r q:f3: ;r
<br />{ 19)
<br /> MEASUREMENT ' I~f" ~
<br />U ~ 7 b 1 0 ~ U
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<br />' ,•.,; F7MIT - if # # #Q! „" #r-, 31r'~7~~3'l'~-~ .
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<br />S VAL116 q~QUIRENIENT #¢~ ,
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<br />JN, TOTAL SAMPLE ~ -.. #>OT tll dt nrF t,:; o;: ( Ly)
<br />(A ~ F E) MEASUREMENT -
<br />L'J4b 1 U 0 ., ~~ V"P~t:,. ~tk~ ~_ rr` #A~Y ~. .~~ '#'
<br />~ r~'x:~- 1 ~~"
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<br />'r'F'LUENT GROSS VALUE
<br />. .IRNT
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<br />'LJJ, IN CONDUIT Ok SAMPLE ~ ~ ~ ( 03) r,#:,.h•:±~ ... r:-tYa~~
<br />i'HU fH~A'f RENT PLA NT MEASUREMENT
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<br />:PFLUdA'T GROSS YALUE ~. RANT x'80 ~1Y.~ • ~; L'p ~~ ~;~-. s~ ~
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<br />IL AND ;REASE SAMPLE .:.~°"•0~ ( 94) ari#tk .fit. ,-., .. ^:p G::: i`.;
<br />L S li A L MEASUREMENT
<br />4 J b h 1 U U "v;: ~ ~ , .,. ~ " ' r' . 5 =1 - ~
<br />N -~A ,. #
<br />'F'FLUENT Gk055 YALUE ~ 0=0 t
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<br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER I Cedify under penalry of law that this document eM a4 ahachmenls were TELEPHONE DATE
<br />
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<br />~~ ~ prepared uMer my direction or supervision In accordance wiN a system desgned
<br />to assure that quall0ed personnel properly gather antl evaluele the ntorrnation
<br />J ~ O
<br />~ S submitted. Based on my inquiry of the parson or persons who manage the system,
<br /> or those persona dnec9y responsible br gaNering the Inlormation
<br />the IMOrtnation
<br />
<br />`7 (J ~ i ' b ,
<br />submitted is , to the best of my knowledge and befiel, true, accurate, end complete.
<br />SIGNATURE OF PRINCIPAL EXEClJT1VE
<br />70 _ L'
<br />7 r
<br />~J
<br />~~
<br />TYPED OR RINTED I am aware that there are signi~raM penalties for submining false information,
<br />Indudm the ossibili of nne and im risonmeM for knowi Nolatio~. OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />VVMMtN I J ANU t].YLANA I IUN VY ANY VIULAI IUNJ (HelereDCe 8l/aR2Cnmenl5 Hale) '
<br />~:;i 5 TOTAL IBO!! LI~'lI'1'S JILL 3d JkLVRD, ASh :iN.'TTL!'AHLi; 57LL`JS LIHL'I APPLICi! FO <=lOYR.,24HR ~PRECIP :VRNT-
<br />~EE 1.A.1, PS V, FOfi dt~lULkd!76NT~. OIL c. GPF;ASF. R_'i'C7~TINh-SEE 1. B. 1. F, PG VII. QkTRLY• SA9PLING
<br />PA orm 3 7 I .3 ~) Prevlbus e ition maybe used. THIS IS A 4•PART FORM PAGE OF
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