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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 024 -A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY MM /DD/YYYY <br />07/01/2015 09/30/2015 <br />Form Approved <br />OMB No. 2040 -0004 <br />DMR Mailing ZIP CODE: 80467 -9704 <br />MINOR <br />Mine Dewatering to Sedimentation Basin Prior to Discha <br />External Outfall <br />No Discharge <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualifies personnel properly gather and <br />valuate the information submitted. Based on my Inquiry of the person or persons who manage the <br />system, or those persons directly responsible for gathering the information the information submitted is + '� <br />6t i ci ^ r 1 to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are <br />Y�s C. 0 significant penalties for submitting fake information including the possibility of fine and imprisonment for SIGNATURE OF PRINCIPAL EXECUTVE OFFICER OR <br />knowing violations AUTHORIZED AGENT <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 />TELEPHONE I DATE <br />1 9-;t S76 2 7S IilC /Z7 // <br />AREACOde I NUMBER I M /DD/YYYY 4 <br />EPA Form 3320 -1 (Rev.01 /06) Previous editions may be used. 07/10/2013 Page 2 <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 />* * * * ** <br />* * * * ** <br />* * * * ** <br />MEASUREMENT <br />013031 0 <br />Effluent Gross <br />PERMIT <br />REQUIREMENT <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />Req. Mon. <br />30DA AVG <br />Req. Mon. <br />DAILY MX <br />ug /L <br />Monthly <br />GRAB <br />Silver, potentially dissolved <br />SAMPLE <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <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 />* * * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <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 />* * * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <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 />* * * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />MEASUREMENT <br />01313 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 />Lead, potentially dissolvd <br />SAMPLE <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <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 />* * * * ** <br />* * * * ** <br />* * * * ** <br />* * * * ** <br />MEASUREMENT <br />0131910 <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualifies personnel properly gather and <br />valuate the information submitted. Based on my Inquiry of the person or persons who manage the <br />system, or those persons directly responsible for gathering the information the information submitted is + '� <br />6t i ci ^ r 1 to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are <br />Y�s C. 0 significant penalties for submitting fake information including the possibility of fine and imprisonment for SIGNATURE OF PRINCIPAL EXECUTVE OFFICER OR <br />knowing violations AUTHORIZED AGENT <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 />TELEPHONE I DATE <br />1 9-;t S76 2 7S IilC /Z7 // <br />AREACOde I NUMBER I M /DD/YYYY 4 <br />EPA Form 3320 -1 (Rev.01 /06) Previous editions may be used. 07/10/2013 Page 2 <br />