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<br />PERMITTEE NAME/ADDRESS (Inclv(le Facilih•Name/Locarion ijDij~rnrnt)
<br />NAME H.LU3 t10UNTAIN ENERGY, INS.
<br />ADDRESSOESERAD~ NINE
<br />!5D) BOUNTY ROAD 65
<br />FACILITY RANGLY CO 81619
<br />LOCATION
<br />grrv: JEFF DuaneRr
<br />NATIONAL POLLUTAtfr DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />PERMIiNUMBER DISCHARGE NUMBER
<br />MONITORI G PERIOD
<br />YEAR .: O DAY EAR MO DAY
<br />FROM 1 T ''0 (i~ 3D
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<br />Form Approved.
<br />OMB No. 2040-0004
<br />t+I'•DR
<br />(SUER NY)
<br />F - FINAL
<br />RP-5 ~^DI PO VD TO RED W45~:
<br />'~#R d0 DISCfSA4Gp: ~a~I~ •'"'~'
<br />NOTE: Read Instructions befo~e'Cbhfpleting this form.
<br />RbLA`
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
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<br />R AVERAGE MAXIMUM UNITS ~ 1NIMUM AVERAGE MAXIMUM UNITS aNALYSIs
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<br /> MEASUREMENT
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<br />'USPENDE:7 MEASUREMENT
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<br />EFFLUENT GROSS VALU AL(tUli)ffC, ++>r•::: "~' ' ;, r•
<br />'DLI05, SBT2LEAULE SAMPLE xt:tc"^~°~ •°`~t< <~"~~~# ( 2'~)
<br /> MEASUREMENT
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<br /> MEASUREMENT
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<br />(A S F F.) MEASUREMENT
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<br />L S U A L MEASUREMENT
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<br />NAMERITLE PRINCIPAL E%ECUTIVE OFFICER ICedity under penalty of law thattllis tlocument antl ell ahachrnents were ~ TELEPHDN @ DATE
<br />-/~} preparetl under my dranlon or 5iparvision in accordance with a system designetl
<br />5C~// ~(~•jiN3 to assure that qualified personnel.propertygatherandevalu~tedleinlortnation
<br />submiltetl. Based on mylnquiry of the pefson or persons who manage the system,
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<br /> The information
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<br />ansible br gathering the Information
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<br />` ~ubmittedls,loNebestbfmyknowletlgeendbelief,true,~ccurat~,andcomplete. SIGNATURE OF PRINCIPALE%ECUTIVE U
<br />TYPED PRINTED lam aware that there are signifwnt panallles for submihing false inbrmation,
<br />inclutlin Iha asSibil~ offne antl im risonment for knowin violations OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />C V MMtN I S ANU tXYLANA I IUN Uh ANY VI V L.H I IUNJ (HerereOCe a/! artdCnlrlen[S Here/
<br />I'SS S 'TOTAL 1R0Y LI!lI'I:i ,:ILL nE 4AIYED, AHD SETTLEAHLe SOLIDS LIMIT APPLI,:D FJB C=l0YR,24HR PRECIP EYFVT-
<br />SEE I. A. Z, PG V, FOti nF.,IUIREflERTS. DLL t: GREASE REPORTING-SEE I.B.1.F, P; VII. ~RTRLF SAlIPLING
<br />be used.
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