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PERMITTEE NAMEIADDRESS (Include Facility Name/Localion i(Different) <br />NAME: Hayden Gulch Terminal Inc <br />ADDRESS: PO Box 670 <br />Hayden, CO 81639 -0670 <br />FACILITY: HAYDEN GULCH LOADOUT <br />LOCATION: 2 MI S OF TOWN, OFF RCR 53 <br />HAYDEN, CO 81639 <br />ATTN: Roy Karo, GM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />COG850008 <br />002 -A <br />PERMIT NUMBER <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />SAMPLE <br />TYPE <br />MM /DD/YYYY <br />04/01/2014 <br />UNITS <br />06/30/2014 <br />Form Approved <br />OMB No. 2040 -0004 <br />DMR Mailing ZIP CODE: 86001 <br />MINOR <br />ROUTT <br />POND (SE/4) TO DRY CRK/YAMPA <br />External Outfall <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 />Oil and grease visual <br />8406610 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />•••••• <br />•••••• <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 />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that tlus document and all attachments were prepared under my dbecbon a L <br />supervislan in accordance with a syslem designed to assure that qualified personnel properly gather and I <br />°Wale Ne Information submitted. Based an my inquiry of the person or persons who manage the <br />Q %k LCCAAyV01 system, or Nose persons directly responsible for gathering the Informabon, the infmmabon submitted is, <br />ANA ' r to Ne becl of my knawtedpe and belle(, We, acarote, end complete. I am aware that Nere are sigrurwaat &n <br />pS.r` (may peno rksf orsubmttingf al seinformatbn, includingthepoas itslityorfineandImprisonmentforknowng SIG IATUREOF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />TELEPHONE I DATE <br />M 111311 lot I7q. <br />AREA Code I NUMBER 1 1- 00YYYV <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />SETTLEABLE SOLIDS LIMITS WAIVED FOR 10 -YR, 24 HR PRECIP EVENT SUBJECTTO BURDEN OF PROOF REQUIREMENTS IN PART I.B.6. ANY ADDITIONAL DATA SHALL BE SUPPLIED TO THE <br />DIVISION WITHIN 48 HOURS. <br />EPA Form 33204 (Rev.01 106) Previous editions may be used. 07121/2014 Page 40 <br />