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PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />EX <br />FREQUENCY <br />OF ANALYSIS <br />SAMPLE <br />TYPE <br />VALUE <br />VALUE <br />UNITS <br />VALUE <br />VALUE <br />VALUE <br />UNITS <br />Oil and grease visual <br />84066 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />"" „.. <br />....”. <br />....•• <br />PERMIT <br />REQUIREMENT <br />"""" <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />"" "" <br />' """ <br />'" "' <br />"'"" "" <br />Twic <br />VISUAL <br />PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME: Blue Mountain Energy Inc <br />ADDRESS: 3607 CR 65 <br />Rangely, CO 81648 <br />FACILITY: <br />LOCATION: <br />DESERADO MINE <br />3607 CR 65 <br />RANGELY, CO 81648 <br />ATTN: ALAN HILLARD, MINE MGR <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />Scott Wanstedt, Environmental Engineer <br />TYPED OR PRINTED <br />EPA Form 3320 -1 (Rev.01106) Previous editions may be used. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />FROM <br />C00038024 <br />PERMIT NUMBER <br />I .entfi under penalty of law that this document and all .tb.hrnent wove preponvl under my dneurou of <br />supervision m weenier,. with a ryatom designed to acsunt Mat qualified pcvsennel properly gather and <br />evaluate the inf etion submitted. Based on my Inquiry of We person or perams who manage the <br />system, or those persons directly responsible for gathenng the informaon. the information submitted is. <br />to the hint of my knowledge and bcbof, true, accurate, and complete. 1 am aware that Mere are sigmf t <br />paudties tar aubmnting tithe Information, Including the pembOdy off and rmpnumnunt for towing <br />violations. <br />028 -A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM/DD/YYYY <br />07/1/2012 <br />MM /DD/YYYY <br />09/30/2012 <br />TO <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />DMR Mailing ZIP CODE: 81648 <br />MINOR <br />(SUBR DW) RBLAN <br />RP5 SEDI POND TO RED WASH <br />External Outfall <br />TELEPHONE <br />(970) 675-4322 <br />AREA Code I NUMBER <br />No Discharge <br />DATE <br />10/25/2012 <br />MMIDD/YYYY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />TSS & TOTAL IRON LIMITS WILL BE WAIVED FOR 10YR,24HR PRECIP. EVENT- SEE I.A.1, PG.3. FOR REQUIREMENTS.OIL & GREASE REPORTING - I.B.1.A.,PG. 13. QRTRLY SAMPLING INSTRUCTIONS - I.C.7.. PG. 14. <br />Form Approved <br />OMB No. 2040-0004 <br />05111/2011 Page 2 <br />