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PERMITTEE NAME /ADDRESS (Include Facility Namekocation if Different) NAME: Moffat County Mining LLC ADDRESS: 29515 Routt CR 27 Oak Creek, CO 80467 -9704 FACILITY: WILLIAMS FORK MINE LOCATION: 1030 CR 107 CRAIG, CO 81626 ATTN: Jerry Nettleton, Supv NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) DISCHARGE MONITORING REPORT (DMR) C00034142 FLOW -A PERMIT NUMBER I DISCHARGE NUMBER MONITORING PERIOD MM /DD/YYYY MM /DD/YYYY 07/01/2015 09/30/2015 DMR Mailing ZIP CODE MINOR Total Flow External Outfall Form Approved OMB No. 2040 -0004 80467 -9704 No Discharge PARAMETER I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance wth a system designed to assure that qualified personnel properly gather and valuate the information submitted. Based on my inquiry of the person or persons who manage the system. or those persons directly responsible for gathering the info anon the information submitted is to the best of my knowledge and belief true, accurate. and complete m aware that there are significant penaflies for submitting false information, including the possibility of fine and imprisonment for QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. EX FREQUENCY OF ANALYSIS SAMPLE TYPE VALUE VALUE UNITS VALUE VALUE VALUE UNITS Flow, in conduit or thru treatment plat 500501 0 Effluent Gross SAMPLE MEASUREMENT * * * * ** * * * * ** * * * * ** * * * * ** PERMIT REQUIREMENT 4.03 30DA AVG Req. Mon. DAILY MX MGD * * * * ** * * * * ** * * * * ** * * * * ** Monthly CALCTD NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance wth a system designed to assure that qualified personnel properly gather and valuate the information submitted. Based on my inquiry of the person or persons who manage the system. or those persons directly responsible for gathering the info anon the information submitted is to the best of my knowledge and belief true, accurate. and complete m aware that there are significant penaflies for submitting false information, including the possibility of fine and imprisonment for f __--- TELEPHONE DATE C 1 7c, 7C �7�Z 27 7 - 0-ri SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR TYPED OR PRINTED nowng violations. AUTHORIZED AGENT AREACOde NUMBER M /DD COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) Report total flow from 003A, 022A and 024A. EPA Form 3320 -1 (Rev.01106) Previous editions may be used. 07/10/2013 Page 1