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PERMITTEE NAME/ADDRESS (Include Faciliry NamelLocanon ijDi$erenp <br />NAME <br />GLUE h117UNTAIN FNERV'1', INC. <br />ADDRESSil ESERADO 1`) I hJE <br />3h07 CTJNTY' ROAll 6;. <br />FACILITYR ANGL'/ CO 81648 <br />LOCATION <br />A)T!•.I~ JPFF' IH IRR FAT <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />:-.v-. ~.~ ~,-, <br />PERMITrNUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM U 7 (1 TO <br />Form Approved. <br />OMB No. 2040-0004 <br />h1 I NOR <br />( ~;UER NW ) <br />F - FINAL. RDl_:;'v <br />RP-4 SED7 PQND TO REU WASH <br />#s~# NC) DISCHARGr I ~I itatat <br />NOTE: Read Instructions befor~mpleting this form. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREgUENC SAMPLE <br />P <br />MET EX OF TYPE <br />ARA <br />ER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS /~'a-ySIS <br />~H SAMPLE #####at at#ataaFaF ##n#r# I"d1 <br /> MEASIIREMEN7 <br />)oulto I G i ~ -PERMIT ~ ~uaFar;tra~.«- =,i-.*(t~y+EM';.~ t#n .:~ xs+r#+-* . 0 ~ EKh:VI ITV <br />.'r ; UCF!-i GRO55 VALVE REQUIREMEfJ7 _ .##.p iC <br />>I]l. t['3. TOTAL SAMPLE ##at#it# ~##### #**### Iy; <br />il1S~'FT.Li}LD MEASUREMENT <br />)033 ~: O O "PfiAMIfi, .'~ <br />' #~n~ - ='~;; <br />- -~ O ~A~ <br />- <br />_FF'! VENT 6R055 VALUE REQUIREMENT " <br />~ ### - AI V ~ L . <br />iOLlD.°.~ SETTLEADLE SAMPLE at###atat at#aratat# alitxat#at ?.`il <br /> MEASUREMENT <br />osas i o o .,.,QE~I~ ~ ` ## ~~~,. R~if'DRT REPCIRT - ~ <br />=FFI LIEN f 6R055 VALUE REQUIREMENT - ' tat#x L. i ; <br />)IL `i GREASE SAMPLE ###arat at ####a.# ?t #al a~n# p-a-tt~#ea Iy ~~ <br /> R <br />MENT <br />MEA <br />S <br />U <br />E <br />//~~CG. L { (~ <br />• l!/~--IV 2 U V yr <br />~~ <br />~~ <br />, ~~ <br />/ <br />'~ "!~L"f'aYll~ <br />'~ ~y,yy y~y~ <br />•.. ~!'a'+iT6R,R3'': y 4~j~y yy <br />.. .eif~4le <br />'h. ~' ,,yyyy~~[[~~ <br />~K~lw•T"R')F. y~ ~Ly <br />**#~*~' T <br />V n /V <br />~~ M y~ <br />~ <br />~~~ A{~ <br />A~ <br />:FFt_UEN7 6R035 VALUE . <br />REQUIREMENT #sx X r.'L - <br />:ROid, TOTAL_ ~ SAMPLE ###at## ##?txat# ?:rftiElt# Iy) <br />( A^a FE } MEASUREMENT <br />}l~'LS 1 U 0 PE)iMIT' ~~4fif~dEdl+rt* MIp:1F#yh# ~+ra ~ ~ri~ <br />. a. _ <br />• 4 '. <br />. <br />$~': <br />Ate <br />:Ff ! DENT 6R DS VA )yl AEQUIREMENT ### ~ <br />F <br />L ^t•!. IN CGND4JIT OR SAMPLE 03) ##ii##it w##at#at ####M# <br />-FIF'U TREATMENT PLANT MEASUREMENT <br />OC-:) '. O O 'PCRMIT -~~P~Ffi; . ~~ <br />' - ~-~ ..- ~ ~ ~ ~~". *# T"AN <br />r, . REQUIREMENT '"" _ <br />'1"L. 4iJD GR.:ASE SAMPLE #aat##~~+ y4) ##it##it #tatx## #?t#,~+t,t <br />r I y-t , 41 MEASUREMENT <br />', ~~~.,o i U O '`PERMIT -_.. ii~#f° _~:. ; '- ..5=1 ~• ;-lriFdKlfiiFiF _' .. ~lF9Fil .## ¢, gkjlq~ <br />t F!.. - T R• Vr REQUIREMENT ~ ~ __ ~ ~ ~ ##~ - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICemy untler penalry of law that Nis documem and all attachmerRa were <br />r <br />ed und <br />r <br />direcLO <br />r <br />ervision in <br />ordance <br />ith <br />stem tl <br />i <br />neo TELEPHONE DATE <br />!, p <br />epar <br />g <br />e <br />my <br />n o <br />sup <br />aa <br />w <br />a sy <br />es <br />j ~~T• ~~a ~ K~ 1 <br />~ <br />~ to assure that qualified personnel properly gather an0 evaluate Ne infomation ~ ~ _~, <br />`~ submined. Based on my Irputry of dre person or persons who mange Vte system, ~~~ <br />~, <br />~ the intpmfallon <br />or those persons direnly msponslble Tor gathering Ne inormation <br />E-.e. <br />~~~ ~- , <br />the best of knowletl a <br />bmmetl is <br />ntl bellel <br />W e <br />azcurata <br />antl c <br />m late <br />t <br />" ~ - <br />~ <br />' ~ <br /> <br />~ i ~ , <br />, <br />, <br />, <br />. <br />su <br />o <br />a <br />o <br />ry g p <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />~/ <br />. <br />::° <br />7L <br />~' <br />' <br />' ~ <br />TYPED OR~PRINTED I am aware that there ere signifcanl penalties br submitting false information, <br />incwdln the ssibili olfne antl im rlsonment for knowin violations. OFFICER OR AUTHORIZED AGENT R <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMEN I S AND EXPLANA I IUN Uh ANY VIULAI IUNS (HetelenCe all aRdCDmen(S D@B) <br />'~Sb q, TD'!A!_ IRON L-IMITS WILL 6E WAIVED, ANC) SETTLEABLE ~O(_iD~: LIi1IT APhLTED FO?: ; iYR, 24~'( ~i(i-':~iF EVFNi- <br />I <br />•_E.E I. A. 2~ PG V, FOR REQUIREMENTS. UIL £:. GREASE RF'PORI"ING-SEE I. u I F, FU ~riT )'+TF2l ~ :,n,aF: <br />„yl <br />F rtk 33 (b~ 3r/99 ~ 4iou iti may be used. THIS IS A 4PAR7 FORM PAGE OF <br /> `-i(242~'JO~J~_2-751 r., i <br /> <br />