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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 />C00034142 003 -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 />No. 6 Mine to Williams Fork River <br />External Outfall <br />No Discharge EJ <br />PARAMETER <br />I certify under penalty of law that this document and al 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 />84066 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />* * * * ** <br />(i <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />TYPED OR PRINTED <br />AREACode <br />,v <br />I <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 />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER <br />I certify under penalty of law that this document and al attachments were prepared under my direction or <br />TELEPHONE <br />DATE <br />supervision in accordance with a system designed to assure that qualified personnel properly gather and <br />valuate the information submitted Based on my inquiry of the person or persons who manage the <br />system arthose persons directly responsible for gathering the information the information submitted is <br />- <br />�r <br />i <br />to the best of my knowledge an belief true accurate and complete I am aware that there are <br />significant penalties for submitting false information including the possibility of fine and Imprisonment for <br />f�7(i <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />knowing violations <br />AUTHORIZED AGENT <br />TYPED OR PRINTED <br />AREACode <br />I NUMBER <br />MM /DDIYYYY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />Oil and grease sample required if visible shee Is observed. Qtrly sampling Instructions - LC 12, pg 11 <br />EPA Form 3320 -1 (Rev.01106) Previous editions may be used. <br />07/10/2013 <br />Page 3 <br />