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PERMITTEE NAME/ADDRESS (Include Paciliry Namv~Zacalian (Different)
<br />NAME
<br />BLUE 'IJ71V'PAIk i.ti';1tSi, INC.
<br />ADDRESSp'':y:~:.-,q DO "L V.•.
<br />FACILITY riP. IV':LY ..~ r+L!.J+
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR)
<br />^nnl ~ c:n, r nn
<br />PERMIT NUMBEfl DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 1 : 71 :.'~ 1 TO 51 'J 1 3 1
<br />M: Or?
<br />- F'T1:AL
<br />rv-L ;3DI
<br />Form Approved.
<br />OMB No. 2040-0004
<br />
<br />NOTE: Read Instructions beloreat$Trlipleting this form.
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<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />M EX of TYPE
<br />PARA
<br />ETER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~'V-~IS
<br />t' SAMPLE ..: :}'. ~:'- ~; rf ?:R^ {: ;: n;:'-~. ( 12)
<br /> MEASUREMENT
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<br />REQUITEMENT
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<br />_;;L:I)-i, _~TAL SAMPLE ~.._7'tt` F:rk:`r=, 's><:>.`~vi,. ( 19)
<br />`' , ~ ;' ;. i-~ c i • MEASUREMENT
<br />U.; ~ (J 1 ' 1, ~ PEp,MI'E;~ :.#tlc9t~'9r~!'
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<br />t~i'~J-;~I 'S .tUL3 'i 4LUr REQUIREMENT ~ ~ - , .+
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<br />:, :. ..i: S, .-.'.rPLF~°.dL". SAMPLE `r;: ~x; pr,, ,xnhr k:x r:r. ( ZS)
<br /> MEASUREMENT
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<br />*_' f P L J :'i !' .; e J 5 5 V ti L U e REQU1FiEMENi ~ k ~~ Vr .
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<br />JiL ;RcA9°. SAMPLE ex'x»:e P's .- :: :•, ;.Krt ;:ri:; .: k.., ,_.~., ( 1U)
<br /> MEASUREMENT
<br />Ji',~4 1 .! 0 ~;'?ERM~IT~ ~ ~ #+k9111GR '16tlki'L'RC$ -3C+ip>def#4 i1Y##e944 - IQ `~ ~,'?i' „~,'.:
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<br />St'r'L1t.~.T ~tJS5 VALU Rtrp01FEMENT _ ~~ - :rt y5 L
<br />Ir.~", OI'A i. SAMPLE -.:.. ,. Y;:r;: -: ~: [:::::},: ,y:.. ( 19)
<br />I R ~ p ;~ MEASUREMENT
<br />') L _) : ti L J 0 PERMIT '.4{X"~~~-04 - ;,~9+}4f+Pi~
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<br />'F'~ LJS" T ;;d~iS~ VALUi• REQUIREMENT ~
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<br />i. J;;, !h [: ;I'a~RiT ;: iT SAMPLE 03j
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<br />" l i J T •) E 9. T "~ . 7J" i Lr, 41 MEASUREMENT
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<br />iL SFJ ~k:...;t: SAMPLE rc.-*ti ~. ( ~L'l) k~..~.. .a;•;,i :. y:z •Ft, .
<br />i ~ J (, L MEASUREMENT
<br />~J~~b 1 J U PERMIT .`Ct~# C# r',~=1 _#~a~0~ O!41k3i~!?¢_-'-_ -...3k~tAdY!fc' '-. : T
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I Cemity under penalry of law that Nis tlocument ono all attachments wero
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<br />1 submihetl. Sasetl on my Inquiry of the person or persons who manage Ne system,
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<br />submitted is , to the best of my knowletlge antl belief, true, , ccurate, end complete.
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<br />l SIGNATURE OF PRINCIPAL EXECUTIVE ~ ~t 1 ~' 15' y "1 ~ O / GZ ._ ~
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<br />TYPED OR PZIINTED se in
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<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here}
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<br />EPA-korm 3320=1~(R 3/J~`~revl()us editions may be used. THIS IS A 4-PART FORM PAGE OF
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