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PERMITTEE NAME/ADDRESS (lnrlrrdeFad7lryNanraZacaNoal<Of,/JvmQ <br />NAME BLUZ i70UNTAIN E!iERGY, INC. <br />ADDRESSDE7EHADD MIRE <br />3D07 COUNTY ROAD 65 <br />FACILITY RANGL,Y CJ 81648 <br />LOCATION <br />ATTN: JSFP llUBBERT <br />PARAMETER I X AVERAGE <br />/SAMPLE` SCaCO <br />MEASUREMENT <br />Duuu 1 u 1 <br />F'FLUENT GROSS YALU <br />)LIDS, ~ T'GYAL <br />OSPENDED <br />U93U 1 U U <br />Ft'LUEtlT CROSS YALU <br />)LIDS, s$T?LE!.BL`: <br />ub4~ 1 D,.,:U <br />FYLUEN2 GRJ.~.S PALU <br />IL ~ GREASe <br />UJb~b I D' ,D <br />LFE'LUENY GR03S YALU <br />IpOy, TOTAL <br />(AS FS1 <br />U1~4', 1 U O <br />LFFLUE~T GROSS YALU <br />FLJa, IN CONDUIT OH <br />Trti:U T'RLsATCIENT PLA:f <br />:~JUSJ 1 0 D <br />~iF'FLUBNY GRDSS YALU <br />~3L1D5, TOTAL <br />U15SOLVeb <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />NATONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDESJ FOrm ApprOYed. <br />DISCHARGE MONITORING REPORT (DMRJ ~ OMB N0. 2040-0004 <br />~TVJT, <br />(SU3k TIM) <br />PERMIT NUMBER DISCHARGE NUMBER F- F I V A L R U L A N <br />MONIIOBING PERIOD SS'1 LOT STOF. AGF. TJ AED .IASN <br />Y ~~' O DAY YEAR MO DAY <br />FROM TO O1 Ub 3. ''~a yC~ DiSCRARG° '=+'r <br />NOTE: Read Instructions before-L'dinpleting this form. <br />Y OR LOAOIN ~ . QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />EX of TYPE <br />MAXIMUM UNI MINIMUM AVERAGE MAXIMUM UNITS ANALY519 <br />.mr..p4c a~faca,~ ( Imo) <br />C~='~a3:t r. 4, Y;<p r: iLyti4>PS ( 19) <br /> {< {- r <br /> _1ty .._.. '~. +T tY'rG <br />r. O.s .}... -r rr,~nr. .-: C{+t+aO#' ( 1~) <br /> r <br /> A ~k C+ <br /> <br />.•. ya <br />.: t,:z74r. M1 r,CO;f K: S'4 iPaKf aaanaa ( 1')) <br />lU1ib 1 J U ;rca <br />F-FFL'Jk:kY GRDSS YALUz ~=?'•' ~.~'~~~ `" '~-t <br />NAME?1TLE PRINCIPAL EXECUTVE OFFICER ICertiy under penalty of law thaz this document and ell attachmenLS were TELEPHONE DATE <br />prepared under my direction or supervision in accordance with a system designed <br />SC ~ ~~"' LUr.~t S to azetxe that queGfied personnel properly gather end evalu&e the Intimation <br />submMetl. 6avetl on rtry Inquiry of the person a persons who manage me system, <br />or (hose pwsona tllmNy responsible br gathadng dte kdomatlon, the inbrmatlan _ <br />L +~ / • ~~ ~ submitted le , Lo the best A my knowledge end b~eL we, ecwrale, end complete. SIGNATURE OF PRINCIPAL EXECUTIVE 70 <br />I em aware Net etere ere slgnmcent peneltles br 9ubmining lake inlormeeon, p NUM E YEAR MO DAY <br />TYPED OR PRINTED includl the wslbili of fine entl i dsonment br knowi vioiatbns. yFFICER OR AUTHORIZED AGENT <br />COMMENTS AND~EXPLANATlON OF ANY VIOLATIONS (Re/erence all attachments here) ,, .,r~' ' <br />C~3 F. 70TdL Ii!DN LI'SIT3 HILL '9 F. aAIYe^, A':i1 SFTTL6'A.PLE SQ.bIDS LTMIT A?PLI~:U F7°. C=R,24Hk pREC]P :'J:J:T- <br />~EE I.A.1, PG Y, FOA kF.]UIRENENTS. OIL 6 GF'F:ASF, RF.POoTING-SEF. i. U. i. F, PG 7TI. Q3 RLY SAI9PLING <br />Tm 3 fYrevidus a pion may be used. ~ T}IIS IS A 4•PART FORM PAGE OF <br />OOG00/OOU717-135D I <br />