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PERMITTEE NAMEIADORESS (include Facility NameA ocation if Different) <br />NAME: <br />Hayden Gulch Terminal Inc <br />ADDRESS: <br />PO Box 670 <br />O <br />Hayden, CO 81639 -0670 <br />FACILITY: <br />HAYDEN GULCH LOADOUT <br />LOCATION: <br />2 MI S OF TOWN, OFF RCR 53 <br />VALUE <br />HAYDEN, CO 81639 <br />ATTN: Roy Karo, Rec Mgr <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />COG850008 002 -A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />MMIDDIYYYY MMIDDIYYYY <br />FROM 07101/2013 TO 1 09/30/2013 <br />Form Approved <br />OMB No. 2040.0004 <br />DMR Mailing ZIP CODE: 8136 -0670 <br />MINOR <br />(SUBR JC) ROUTT <br />POND (SE14) TO DRY CRK/YAMPA <br />External Outfall <br />No Discharge© <br />PARAMETER <br />[ttni1, udnpemlly aflaw duUhicdoctmrcnl andoll nlL ,nl,,,z pmpamd un&, )- dir U.. or <br />zu"" on in oerndon enith emJcsignal base uc al '_ i,.'w iwnncl xaperl, FadxranJ <br />ewlunle the inf aiinn"batiati. tmn d on my inquiry ores Pe .nr persona nlwmwge nw <br />s' stun. or lhoee pemnaditectlP responsible for gsthcring the iafonnalimt. We inronnalion sv�toitled is, <br />to the th•normyktwnleJ5a nml belief. Inw.accemte, and coot Ids. l am ew'vo tlul there am eiFttifimM <br />petmiraibniiumgralsninC onrtalien .incladineu,epotzibiiitrer� ar.timpri>auonutocl:tawine <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />O <br />OFANALYS S SAMPLE <br />TYPE <br />VALUE <br />VALUE <br />UNITS <br />VALUE <br />VALUE <br />VALUE <br />UNITS <br />Oil and grease visual <br />SAMPLE <br />...... <br />.l..«" <br />...... <br />...... <br />...... <br />MEASUREMENT <br />840661 0 <br />Effluent Gross <br />PERMIT <br />REQUIREMENT <br />Req. Mon. <br />INST MAX <br />Y=1;N =0 <br />••••`• <br />`• " "` <br />«••' "' <br />•• "" •" <br />T Months! <br />VISUAL. <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER <br />[ttni1, udnpemlly aflaw duUhicdoctmrcnl andoll nlL ,nl,,,z pmpamd un&, )- dir U.. or <br />zu"" on in oerndon enith emJcsignal base uc al '_ i,.'w iwnncl xaperl, FadxranJ <br />ewlunle the inf aiinn"batiati. tmn d on my inquiry ores Pe .nr persona nlwmwge nw <br />s' stun. or lhoee pemnaditectlP responsible for gsthcring the iafonnalimt. We inronnalion sv�toitled is, <br />to the th•normyktwnleJ5a nml belief. Inw.accemte, and coot Ids. l am ew'vo tlul there am eiFttifimM <br />petmiraibniiumgralsninC onrtalien .incladineu,epotzibiiitrer� ar.timpri>auonutocl:tawine <br />1 <br />i <br />q <br />hrj�/r <br />S1G ATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />TELEPHONE <br />DATE <br />(� ��% (a �3 -�7'� <br />I� '"t <br />w `- <br />{ <br />4 — tal`ALllr; 1G• <br />AREA Code <br />NUMBER <br />MMJDDNYYY <br />TYPED OR PRINTED <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />SETTLEABLE SOLIDS LIMITS WAIVED FOR 10 -YR, 24 HR PRECIP EVENT SUBJECTI-O BURDEN OF PROOF REQUIREMENTS IN PART I.13.6. ANY ADDITIONAL DATA SHALL BE SUPPLIED TO THE DIVISION WITHIN 48 HOURS. <br />EPA Form 3320 -1 (Rev.01106) Previous editions may be used. 0110412013 Page 2 <br />