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PERMITTEE NAME /ADDRESS (Include Facility Name /LocationifDifferent) <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 1 003 -A <br />PERMIT NUMBER I I DISCHARGE N ER <br />MONITORING PERIOD <br />MM /DD/YYYY MM /DD/YYYY <br />10/01/2013 12/31/2013 <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 <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 />�.J <" <br />TYPED OR PRINTED <br />AREA Code <br />NUMBER <br />MM /DDrrm <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <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 />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. or those persons directly responsible for gathering the information. the information submitted is <br />to the best of my knowledge and belief. true, accurate. and complete. I am aware that there are <br />/} <br />�J G <br />} � i <br />}� I T, <br />9;t <br />SIGNATURE OF PRI IPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />significant penalties for submitting false information. including the possibility of fine and imprisonment for <br />now+ng violations. <br />�.J <" <br />TYPED OR PRINTED <br />AREA Code <br />NUMBER <br />MM /DDrrm <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 - I.C.12, pg 11. <br />EPA Form 3320 -1 (Rev.01106) Previous editions may be used. <br />07/1012013 <br />Page 4 <br />