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PERMITTEE NAME /ADDRESS (Include Facility Name/Location if Different) <br />NAME: Moffat County Mining LLC <br />ADDRESS: 29515 Routt CR 27 <br />Oak Creek, CO 80467 -9704 <br />FACILITY: WILLIAMS FORK MINE <br />LOCATION: 1030 CR 107 <br />CRAIG, CO 81626 <br />ATTN Jerry Nettleton, Supv <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />000034142 024 -A <br />PERMIT NUMBER I DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD /YYYY MM /DD /YYYY <br />07/01/2013 09/30/2013 <br />Form Approved <br />OMB No 2040 -0004 <br />DMR Mailing ZIP CODE: 80467 -9704 <br />MINOR <br />Mine Dewatering to Sedimentation Basin Prior to Discha <br />External Outfall <br />No Discharg <br />PARAMETER <br />I certify under penalty of law that this document and all attachments were prepared under my direction or <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 />840661 0 <br />,Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />* * * * ** <br />1 .t 11 'L V <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />�%'.: 1 ; �r `' ') 1 <br />significant penalties for submitting false information, including the possibility of fine and imprisonment for <br />kn—rig violation <br />PERMIT <br />REQUIREMENT <br />* * * * ** <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />* * * * *` <br />* " * * ** <br />* * * *'* <br />' * * * ** <br />Twice Per <br />Month <br />VISUAL <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER <br />I certify under penalty of law that this document and all attachments were prepared under my direction or <br />f" <br />TELEPHONE <br />DATE <br />supervision in accordance wrath a system designed to assure that qualified personnel property gather and <br />evaluate the information submitted Based on my inquiry of the person or persons who manage the <br />system, or those persons directly responsible for gathering the information the information submitted is <br />L <br />-� <br />1 .t 11 'L V <br />to the best of m knowledge and belief true accurate and complete 1 am aware that there are <br />) "? <br />I7 7c✓r��L� <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />�%'.: 1 ; �r `' ') 1 <br />significant penalties for submitting false information, including the possibility of fine and imprisonment for <br />kn—rig violation <br />TYPED OR PRINTED <br />AREA Code <br />NUMBER <br />MM /DDIVYYY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />Oil and grease sample required if visible sheen is observed. Qtrly sampling instructions - I C 12, pg 11 <br />EPA Form 3320.1 (Rev.01106) Previous editions may be used. <br />07/10/2013 <br />Page 4 <br />