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PERMITTEE NAMEIADDRESS (Include FacifftyName/Locahon if 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 001 -A <br />PEMNITNUMBER I I DISCHARGETU—MBER <br />MONITORING PERIOD <br />MM /DD/YYYY MWDD/YYYY <br />V 1 1213112014 <br />Form Approved <br />OMB No. 2040 -0004 <br />DMR Mailing ZIP CODE: 86001 <br />MINOR <br />ROUTT <br />POND (SW 14) TO DRY CRK/YAMPA <br />External Outfall <br />No Discharge <br />PARAMETER <br />I— tyundmpe . flaw Mat lhls document and eHmomenb were Prepared under myditectlma <br />supavisian in accordance wah a syGem designed b assure Met qualified personnel property gamer end <br />aluab Me information submitted. eased on my Inquiry of Me person or persons vAm menage Me <br />system, or ame persons direslly responsible for gathering the information, the information submi u, <br />b the best G my knowledge and befief, We, accurate. and complete. I am smove that doe we a pMlkaN <br />tkator wbmiltlnghlsemlarmatkm, heWdingthepoaslbiilyol fneandhapriseamerkforkrwwing <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 />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER <br />I— tyundmpe . flaw Mat lhls document and eHmomenb were Prepared under myditectlma <br />supavisian in accordance wah a syGem designed b assure Met qualified personnel property gamer end <br />aluab Me information submitted. eased on my Inquiry of Me person or persons vAm menage Me <br />system, or ame persons direslly responsible for gathering the information, the information submi u, <br />b the best G my knowledge and befief, We, accurate. and complete. I am smove that doe we a pMlkaN <br />tkator wbmiltlnghlsemlarmatkm, heWdingthepoaslbiilyol fneandhapriseamerkforkrwwing <br />e <br />TELEPHONE DATE <br />f <br />C(77sE <br />itilti O <br />�j p [��� <br />'°lZp 913 K1p Ot <br />SIGMA <br />EOFPRINCIPALEXECUTIVEOFFICEROR <br />AUTHORIZED AGENT <br />TYPED OR PRINTED <br />ae£a coda <br />I NUMBER I MWDDJYYYY <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 INPART I.B.B. ANY ADDITIONAL DATA SHALL BE SUPPLIED TO THE <br />DIVISION WITHIN 48 HOURS. <br />EPA Form 3320 -1 (Rev.01106) Previous editions may be used. 07/21/2014 Page 46 <br />