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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 />[A,LHARGE MONITURuN,:: - -E.= "J !f iLia "s :r <br />000034142 022 -A <br />PERMIT NUMBER I I DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY MM /DD/YYYY <br />01101/2014 03/31/2014 <br />DMR Mailing ZIP CODE: 80467 -9704 <br />MINOR <br />Spoils Springs to Channel Prior to Discharge to Williams <br />External Outfall <br />No Discharge <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments ti=re prepared under my direction or TELEPHONE DATE <br />supervision in accordance wth a system designed to assure that qualified pe+ son rel properly gather and °° �) _ - -_ <br />_-valuate the information submitted Based on my inquirf of the person or persons who manage the ' } . , . j" /, 6�" L <br />. _ .. system or those persons directly responsible for gathering the information the information submitted is <br />-'s- 'o the best of my knowledge and belief true accurate and complete I am av are that there are �y�.` A i .^Y fry i ,F 2Z (3 <br />i <br />C r Y G t f =t m�r-� 1j i significant penalties for submitting false information including the possibifty of fine and imprisonment for SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR V <br />¢novnng violations AUTHORIZED AGENT <br />TYPED OR PRINTED AREA Code NUMBER MMIDDIYYYY <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 />Previous editions may be used. F'agi- <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FREQUENCY <br />SAMPLE <br />PARAMETER <br />EX <br />OF ANALYSIS <br />TYPE <br />VALUE <br />VALUE <br />UNITS <br />VALUE <br />VALUE <br />VALUE <br />UNITS <br />Zinc:, potentially dissolved <br />SAMPLE <br />' * * * ** <br />MEASUREMENT <br />013031 0 <br />PERMIT <br />* * * * ** <br />* * * * *` <br />* * * * ** <br />* * * *`* <br />Req. Mon. <br />Req. Mon. <br />ug /L <br />Monthly <br />GRAB <br />Effluent Gross <br />REQUIREMENT <br />30DA AVG <br />DAILY MX <br />Silver, potentially dissolved <br />SAMPLE <br />MEASUREMENT <br />013041 0 <br />PERMIT <br />* * * * ** <br />* * * * ** <br />* * * * *` <br />* * * * ** <br />Req. Mon <br />Req. Mon. <br />ug /L <br />Monthly <br />GRAB <br />Effluent Gross <br />REQUIREMENT <br />30DA AVG <br />DAILY MX <br />Copper, potentially dissolved <br />SAMPLE <br />MEASUREMENT <br />013061 0 <br />PERMIT <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />Req. Mon. <br />Req. Mon. <br />ug /L <br />Monthly <br />GRAB <br />Effluent Gross <br />REQUIREMENT <br />30DA AVG <br />DAILY MX <br />Arsenic, potentially dissolved <br />SAMPLE <br />MEASUREMENT <br />013091 0 <br />PERMIT <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />*` * * ** <br />* *` ** <br />Req. Mon. <br />ug /L <br />Monthly <br />GRAB <br />Effluent Gross <br />REQUIREMENT <br />DAILY MX <br />Cadmium, potentially dissolvd <br />SAMPLE <br />MEASUREMENT <br />013131 0 <br />PERMIT <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />Req Mon. <br />Req. Mon. <br />ug /L <br />Monthly <br />GRAB <br />Effluent Gross <br />REQUIREMENT <br />30DA AVG <br />DAILY MX <br />Lead, potentially dissolvd <br />SAMPLE <br />MEASUREMENT <br />0131810 <br />PERMIT <br />* * * * ** <br />* * * " ** <br />* * * * ** <br />* * * * *` <br />Req. Mon. <br />Req. Mon. <br />ug /L <br />Monthly <br />GRAB <br />Effluent Gross <br />REQUIREMENT <br />30DA AVG <br />DAILY MX <br />Manganese, potentially dissolvd <br />SAMPLE <br />MEASUREMENT <br />01319 1 0 <br />PERMIT <br />* * * * ** <br />* * * * *' <br />' *' * ** <br />*` * *`* <br />Req. Mon. <br />Req. Mon. <br />ug /L <br />Monthly <br />GRAB <br />Effluent Gross <br />REQUIREMENT <br />30DA AVG <br />DAILY MX <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments ti=re prepared under my direction or TELEPHONE DATE <br />supervision in accordance wth a system designed to assure that qualified pe+ son rel properly gather and °° �) _ - -_ <br />_-valuate the information submitted Based on my inquirf of the person or persons who manage the ' } . , . j" /, 6�" L <br />. _ .. system or those persons directly responsible for gathering the information the information submitted is <br />-'s- 'o the best of my knowledge and belief true accurate and complete I am av are that there are �y�.` A i .^Y fry i ,F 2Z (3 <br />i <br />C r Y G t f =t m�r-� 1j i significant penalties for submitting false information including the possibifty of fine and imprisonment for SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR V <br />¢novnng violations AUTHORIZED AGENT <br />TYPED OR PRINTED AREA Code NUMBER MMIDDIYYYY <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 />Previous editions may be used. F'agi- <br />