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PERMITTEE NAME/ADDRESS pndude Faci(iry NomelLocarion iJDrBerenq
<br />NAME BLUE `i7UNTAIFd ENERGY, INC.
<br />ADDRESSDggnkADO F7ItlS
<br />3607 CODNTT ROAD 55
<br />RANGLY CD 916LLB
<br />FACILITY
<br />LOCATION
<br />ATYN: JEFF UUNbEHT
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMfl)
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<br />MIT NUMBER : DISCH.4R E NUMHER
<br />FROM
<br />Form Approved.
<br />OMB No. 2040-0004
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<br />- FINAL kfiLAN
<br />RP-2G3 SEDI POND ".'i! .,~';l w.4:i''
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<br />~~ ead Instructions before completing fhis form.
<br /> QUANTITY OR LOADING QUANTITY OR C TION N0. PAEQUENC SAMPLE
<br />PARAMETER EX aF TYPE
<br /> AVERAGE MAXIMUM UNI MINIMUM AVERAGE MAXIMUM UNITS ANAlrsts
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<br /> MEASUREMENT _ ~ ''
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<br />TN:[D TB EA T!7ENT PLA~1 MEASUREMENT
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<br />V I S U A L MEASUREMENT
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<br />NAMERITLEPRINCIPAL EXECUTIVE OFFICER ICeniy under penely of law that fhis document and all anacnments were TELEPHON E DATE
<br /> prepared under my tlireclion or supervision in accordance wiN a system aeslgnatl
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<br />Y-}- / V ,H S ~'~ t' to assure that qualified personnel properly gather and evaluate the inhimatbn
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<br />N L- ~~ submmad is, to the best of my Mnowledge end beliel, We, eccurele, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE ~
<br /> I em aware thel (here ere signdicant penalties for subnxtting false mtormation, OFFICER OR AUTHORIZED AGENT NUMB R' YEAR MO DAY
<br />TYPED OR P NTED Indudin the ossbJl of fne and im risonment for Mnawi violations.
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />TSS t. T7TAL IHOti LINTS 4CLL UE )IRIYE;D, A'JD SYTTL°A£~LE SOL1U5 LI`IT APPLID FU4 C=IOYR~j.lipR PRECIP EVF.NT-
<br />.,i:L' I•A.2, Po Y~ FD;i KF;)L'IRSML•'NT~. JIL G .N FA. :SE f2Fe0kTING-SE£ I•B.1.E, !"~ V[I• Q(;TREY $AFIPLING
<br />PA Form 33201 (R Y 3 4 revi use lions may be used. T[~IS T FORM PAGE OF ,.
<br />005061000717-~ 1'
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