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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 022 -A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY MM /DD/YYYY <br />04/01/2014 06/30/2014 <br />Form Approved <br />OMB No. 2040 -0004 <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 F1 <br />PARAMETER <br />lorrry under penalty of law that this document and all anaehment swere pre pared unde;, 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 />? <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />V <br />/ <br />�� <br />� <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 />lorrry under penalty of law that this document and all anaehment swere pre pared unde;, direction or <br />J <br />TELEPHONE <br />DATE <br />sup in accordance with a system designed ned to assure that qualified personnel properly gather and <br />�. ., _. <br />the formatio subm t d. Eased on my ngdry of the person persons who manage the <br />!1 <br />j <br />�; f' <br />syst m or those persons directly responsible for gather ng the information . the informais nsubmed -s. <br />to the best of my knowledge and belief, t ue. accurate. and complete. I am aware that there are <br />v <br />- <br />Y � �- <br />IN [[[ > (�'J <br />sig r t penal es for submitting false information, including the possibility of fine and imprisonment for <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />t <br />`17( is*?0 �7�� I <br />� r f " <br />TYPED OR PRINTED <br />vowing violations. <br />AUTHORIZED AGENT <br />AREA Code <br />NUMBER <br />M fDDfYYYY <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 />EPA Form 3320 -1 (Rev.01 106) Previous editions may be used. 07/10/2013 Page 4 <br />