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PERM ITI EE 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 />,hhi BARGE MONI T GMNG KE:i -O�J t0li iR, <br />000034142 003 -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: 80467 -9704 <br />MINOR <br />No. 6 Mine to Williams Fork River <br />External Outfall <br />No Discharge <br />QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br />PARAMETER VALUE VALUE UNITS VALUE VALUE VALUE UNITS EX OF ANALYSIS TYPE <br />Oil and grease visual SAMPLE <br />MEASUREMENT <br />840661 0 PERMIT * * *' ** Req. Mon. Y =1,N =0 * * * * ** * * * * ** ' * * * *' * * * * ** Twice Per VISUAL <br />Effluent Gross REQUIREMENT INST MAX L Month <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER <br />I certify under penalty of lawthat this document and all attachments were prepared under my direction or <br />TELEPHONE <br />DATE <br />supervision in accordance wth a system designed to assure that qualified personnel properly gather and <br />.valuate the information submitted Based on my inquiry of the person or persed —d. manage the <br />or those directly responsible for themfoimal— the information submitted is <br />-------- <br />'y^� °�' °'°• �-n <br />" <br />• rsr « .- ,1....,,,� <br />system persons gathering <br />to the best of m knowied d behet r tie accurate and win fete I am aware that there are <br />_ <br />«� _ <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />significant penalties for submitting false information including the possibility of fine and imprisonment far <br />,' <br />I<nowrng violations <br />AUTHORIZED AGENT <br />AREA Code <br />NUMBER <br />M /DD/ <br />TYPED OR PRINTED <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 />0LIc: Prevlcus editions may be used. <br />J f: 1;! Ol <br />ra_R= -• <br />