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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, Sup <br />vlai.HARGE MONITORING REF OF, i (uPoiR) <br />000034142 FLOW -A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />_ MM /DD/YYYY MM /DD/YYYY <br />01/01/2014 03/31/2014 <br />DMR Mailing ZIP CODE: <br />MINOR <br />Total Flow <br />External Outfall <br />80467 -9704 <br />No Discharge <br />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 />Flow, In conduit or thru treatment plat <br />SAMPLE <br />MEASUREMENT <br />500501 0 <br />PERMIT <br />4.03 <br />Req. Mon <br />MGD <br />* * * * *' <br />* * * * ** <br />* ***** <br />Monthly <br />CALCTD <br />Effluent Gross <br />REQUIREMENT <br />30DA AVG <br />DAILY MX <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments %ere prepared under my, di"'t" of <br />supervision in accordance with a system designed to assure that qualified personnel properly gather and �"f <br />valuate the information submitted Based on my inquiry of the person or persons Wno manage the a:� e ��✓ }_— _ —= <br />system or those persons directly responsible for gathering the information the informaton submitted is <br />--<_.. • - to the best of my knowledge and belief true accurate and complete I am avare That there are <br />significant penalties for submitting false information including the possibility of fine and imprison mene for SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />knowma violations AUTHORIZED AGENT <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />Report total flow from 003A, 022A and 024A. <br />3F . F cmz ?0 I,T' >.,C 1h)tI FI'eViOnS editions may be used. <br />TELEPHONE DATE <br />� <br />AREA Code <br />NUMBER <br />MOIDD7 <br />