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PERMITTEE NAME/ADDRESS pnclude Focillry Nmw/fncarbn IJDijjerorq <br />NAME BLUE hJi)~1'Alrt F:~c.i'GY <br />-• IVC. <br />ADDRESSDESE8AD0 ^fIN~ <br />36V7 COUNTY ROAD 65 <br />FACILITY I{ANGLY CO 91647 <br />LOCATION <br />1 fiTIN: JP,PF 7lBii^'.'{T <br />f 1 <br />PARAMETER <br />YISUAL <br />y~1Ub6 1 0 (i <br />i;f'PLUEHT GHOS6 7A <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDES) <br />DISCHMGE MONITORING REPORT (OMRJ <br />.- PERMIT NUMBER UMBER <br />FROM <br />AVERAGE I MAXIMUM <br />,::ky <br />( ^'t l <br />~5=1 <br />tJ0=0 <br />MINIMUM <br />rkriv$is ::i <br />Form Approved. <br />OMB No. 2040-0004 <br />~T?.DS <br />(SUHH Nis) <br />- FI:iJIL RI+LAY <br />?P-2f.3 SEDI POND TO a[:D +fASt <br />'r°~ISCH~RG° ~ I '{`~ <br />N sad Instruclgn5 befofpleting this form. <br />)NCENTRATION ~ NO. FRE~uENC SAMPLE <br />. - ..' .EX' OE TYPE <br />vttv~at R MAXIMUM UN47." ~ ANALY5rS <br />:t ~~.. ,.t YhO4+k0 <br />..._..'4 <br />NAMElT4TLE PRINCIPAL EXECUTVE OFFICER ICerIRyuMer panalryabwhhnt "a aocumarn end otl enncMnems wars TELEPHONE GATE <br />preparetl antler my tllreclion or s Weryillarin accordance with a system tlaelgned <br />Cp (~( Y15 ~ to assure that quaAHetl personnel properly gather end evaluate the lnbmbtion <br />_ cubnlded. Brood on oy Nqulrydthe parsons pereoru who menage the system, <br />LL a tlrose person! OlreNy reeponelbb M gaNanng Ne Inbrmatlon, the Iriloimation //'' <br />~ V~ (~, L ~ ~q r submaled b , b Ne beet of my bawktlge and ballet, true, eaurete, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE ~ ~ ~ ~7~ Or ~~ <br />TYPED OR PRINTED taro ewarethet there ere¢Ignifical penalties br eubmMing salsa inbmution, OFFICER OR AUTHOR12ED AGENT NUMBER YEAR MO DAY <br />~Includin the ealbili olfne antl im risonm¢m br knowin Noletlone. <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />Ins ~ TOTAL IHON LItfITS GILL 3`: d6tYc;J, AVC `L.TLtA!dL_ SOLIDS LI'7f^ AFPLIr",D FJH <=lOYRl24HR PRECIP P:YFfv:- <br />5EE I.A.Z, PG Y, FOtt R3gUI~?'1F.NT.:. JIL `.: G"r,F,ASt ^.rnRTIHG-GF..P I.9.I.F, SG Yfi. ~;RTP.LY SAl1PLING <br />PA orm 332 E 3 9 -Previ use pions ma be used. IS PART FORM . PAGE OF <br />Y nn=o9~ooo~i~l-~~3~- 2 <br />