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<br />PERMITTEE NAME/ADDRESS (/nc(ude Faci(iry Name/Locanon i(Dif(ermt/
<br />NAME BLUe: NOU~TAIn Eht:itGY, INC•
<br />ADDRESSptS Ek ADD '1INE
<br />3b07 COUN'"Y ROAD 55 '
<br />RANJLY CO °16 J?
<br />FACiuTv
<br />LOCATION'.
<br />ATTN: JEFY UURHF.R1'
<br />NATIONAL POLLI!(ANr DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR)
<br />"' - _ PERMIT NUMBER SCHARGE NUMBER
<br />_ MONITO IN6 PERIOD
<br />Y MO D ~- ~-' YEAR MO DAY
<br />FROM TO ~ 1 ~'{ 10
<br />Form Approved.
<br />OMB No. 2040-0004
<br />? j'iJC?
<br />(5'183 tiW)
<br />,° - FINAL
<br />~!;irAG' T!iF;ATCF'Ni FLANT
<br />NOTE: Read Instrudipp~etd~e~leting this form.
<br />RJLAt;
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION ~ NO. FREOUENC SAMPLE
<br />PARAMETER EX OF TYPE
<br /> AVERAGE MAXIMUM UNIT MINIMUM AVERAGE MAXIMUM UNJ7S ANALIS(S
<br />tiJD ~-DAf
<br />SAMPLE noaaaa ~no~-.r
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<br />(dD DEU. C) MEASUREMENT
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER ICenity under penelry of law roar this tlocumentand all attachments were TELEPHDN 6' DATE
<br /> prepared under my dnaaion or supervision in accordance wiN a system designed
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<br />CD /1.$ to essurathat qualified personnel properly gather and evaluazethe inlomrafion
<br /> subminetl. Based on rty inquiry o/the person ar persons who manage fhe system,
<br />Neinformation
<br />the lnfarmetlon
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<br />onsiblefor
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<br />1~ L ~ submined is , to the best of my Nnowledge antl belief, true, accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE ~ O / U
<br />
<br />TYP OR PRINTED I am aware that there are significant penalties br submiNng false information,
<br />includin rho ossibili offneand im nsonment for knavnn violations. OFFICER OR AUTHORIZED AGENT A NUMBER" YEAR MO DAY
<br />GVMMtN15 ANU tXYLANAI1UN Ur ANY VIVLA IIVNS (He/BBOCe all aRaonmenrs ne/e) '
<br />iFLUE'if 5AKPL~S nU3T 8° .OLLECZED, ANALY.:Xi` t; REPOHTF.D 10STHLY HcUARULi:;; JF aNCTHER A1t,BFPLUI'NT
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<br />DISCHARGE OCCOR~.
<br />EPA Four 3320.1 (REV 3/99) Previous editions may be used.
<br />.., Q07~23/00:0.7
<br />FORM PAGE OF
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