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<br />PERMITTEE NAMEIADDRESS Qnolude Faciliry NamalLoranon ifDiffereny <br />NAME BLUE >'JF1'AIH t.ti'-.li:?, 1~:;:. <br />ADDRESSDG'SERADU 'SINE <br />3607 COi7w7T ROAD 65 <br />FACILITY HANGLY CO 81641 <br />LOCATION <br />ATTN: J$FP UUbHEAT ,`a . <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <br />DISCHARGE MONITORING REPORT (OMR) <br />MIT NUMBER DISCHARGE NUMBER <br />MON IN PERIOD <br />YEAR MO DAY ' ~'• YEAR MO DAY <br />FROM 4 D : ~1 1 04 30 <br />`!Iti )F, <br />~sJar wad <br />F - FINAL <br />f:A-1 LuAUGUT <br />TO R^•.D RASH <br />N~ D:,~C9ARGr ~ *'~# <br />NOTE: Read Instructions before-CSrtipleting this form. <br />Form Approved. <br />OMB No. 2040.0004 <br />RfiLA~ <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER ~ EX OF TYPE <br /> AVERAGE MAXIMUM MINIMUM'. AVERAGE MAXIMUM UNITS ~~~/S <br />OI.IF?Rh, PE.:A:, SAMPLE ~'~"$`1'= PRRSrpa Rti~COtC ( 13) <br />E N E RA L MEASUREMENT <br />l4J~b . 1 ~ U U ~- •PERMIT #~~QAtlk ;t !: _5 <br />EFFLUENT GEOSS VALUE RECIf11REMENT ." ~ '"~ `~~ ~;.t ""' ~`°-^~ .~;, <br />..': -, <br />IL Afltl :.REASE SAMPLE •. • . ( 94~ a aacaOk ao~a:~a <br />I i U A L MEASUREMENT s <br />, <br /> . <br />4J65 1 U 0 tiS~P~RMIT +tAl>rQ6fi F" l=1 ~ <br />,FPLUF.NT GRO55 YALJr ~UIREMENT wST 1 L ~'O=C I';`~--~. ;;-r ~` :k4 ~ v~~= a- 'r <br /> SAMPLE <br />~ <br /> MEASUREMENT 'y' <br />~ $' <br /> <br /> AEQUIREM~NT ~ { F +s°'a <br />' *s M ~,: <br /> :; .. ,; <br /> SAMPLE <br /> MEASUREMENT <br /> - <br /> AF:QUIF7EAtS~NT ' <br />~' .~~ 4i• :).. ! <br /> , , _ , <br /> SAMPLE <br /> MEASUREMENT <br /> ~~ ~ ~ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ~ ' <br /> ~~.~~~cgTFiv~ - r~., -. r'~ I'" ~ <br />~ <br /> SAMPLE <br /> MEASUREMENT '~ <br /> r. <br /> ~ ( <br />J t ~ y rr' 1 ~ ~t. r.~~~ • <br /> . <br />vYi <br />r ~ <br /> <br />~ ~. <br />~ <br />NAME/TREE PRINCIPAL EXECUTIVE OFFICER ICeNy under penalty ollaw chat this document end all anachmenrs were <br />i <br />~ TELEPF{QN DATE <br />}} _ JJ <br />L <br />'t <br />""' <br />a prepared untler my direabn or supems <br />on in accordance wdh esystem tlesigned <br />to assure that pualified personnel properly gather and evaluate the in/onnalion - <br />D,/ y <br />CG~/ <br />s submitted. Based on my Irpuiry of me person or persons wtw menage the system, _ <br />_ <br />( or those persons tlirecny msponslble for gathering the inlormetlon <br />iha in/ormation <br />. <br />~ Yl <br />( <br />r7 V , <br />subminetl is <br />to the best of m <br />knowlotl <br />e entl ballet <br />e <br />accurate <br />r <br />m <br />let <br />t <br />tl <br />7~ / 1, ., l <br />b7 <br />~'~}3iu <br />~ <br />Z <br />~ <br />. , <br />y <br />g <br />, <br />, <br />i <br />p <br />ru <br />, a <br />co <br />e. SIGNATURE OF PRINCIPAL EXECUTIVE . <br />. O/ <br />TYPED OR PRINTED I am atrdre that tlxre am signnlrant penalties for submitting false intwmahon, <br />indudin the ssib'li olfne and im risonment for knowin vrolations. OFFICER OR AUTHORIZED AGENT (.(U (~ YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence au attachments here) <br />AIL G SREASE R>;POHTING-SEE I.8.1.F, PS VII. QRTRLT SA7!FLING IYSTRUCTIONS-I.C.B; P6 ~~`.` <br />? _, <br />,i <br />EPA Form 3320.1 (REV 3/99) Previous editions may be used. <br />~ ~ .THIS ISA4•PART FORM PAGE <br />oos ~/opo~i~-i3so z <br />