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PERMITTEE NAME /ADDRESS (Include FacilityName/Location ifDifferenQ <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 />ATfN: Jerry Nettleton, Sup <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />000034142 003 -A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY MM /DD/YYYY <br />1/1/2015 3131/2015 <br />Form Approved <br />OMB No. 2040-0004 <br />DMR Mailing ZIP CODE: 80467 -9704 <br />MINOR <br />No. 6 Mine to Williams Fork River <br />External Outfall <br />No Discharge <br />NAME IfITLE PRINCIPAL EXECUTIVE OFFICER <br />Ictturyu nderpenalt yofWwpwt Uxadoco metandamatlachmentswerepreparedundermydreclwnor <br />supennsion in accordance with a system designed to assure that quaLfed personnel properly gather and <br />le Ne information sub titled. Based on my Inquiry of the person a persons who manage tlro <br />system. a Nose persons directly responsible for gathering the information. the Infomahon subrmlled is. <br />to Na best of know) and betel. We. aca2le. and compote. I am aware that Here are <br />signif— tparphl for subminingf else mformatio n. inciodng the possblayoffine and 'anpdsonmemfar <br />owing nolatians. <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FREQUENCY <br />SAMPLE <br />PARAMETER <br />^REACOdB <br />EX <br />OF ANALYSIS <br />I <br />TYPE <br />VALUE <br />VALUE <br />UNITS <br />VALUE <br />VALUE <br />VALUE <br />UNITS <br />Oil and grease visual <br />SAMPLE <br />" "" <br />"' "` <br />" "" <br />" "" <br />` "' "" <br />MEASUREMENT <br />8406610 <br />PERMIT <br />" "" <br />Req. Mon. <br />Y =1;N =0 <br />" " "" <br />" "'" <br />" "" <br />" "" <br />Twice Per <br />VISUAL <br />Effluent Gross <br />REQUIREMENT <br />INST MAX <br />Month <br />NAME IfITLE PRINCIPAL EXECUTIVE OFFICER <br />Ictturyu nderpenalt yofWwpwt Uxadoco metandamatlachmentswerepreparedundermydreclwnor <br />supennsion in accordance with a system designed to assure that quaLfed personnel properly gather and <br />le Ne information sub titled. Based on my Inquiry of the person a persons who manage tlro <br />system. a Nose persons directly responsible for gathering the information. the Infomahon subrmlled is. <br />to Na best of know) and betel. We. aca2le. and compote. I am aware that Here are <br />signif— tparphl for subminingf else mformatio n. inciodng the possblayoffine and 'anpdsonmemfar <br />owing nolatians. <br />�� V <br />TELEPHONE DATE <br />\ <br />0+14 <br />/� �� �.�� �� <br />SIGNATURE OFPRINC L EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />TYPED OR PRINTED <br />^REACOdB <br />NUMBER MMIDD/YYW <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />Oil and grease sample required if visible Shea is observed. Qtrly sampling instructions - I.C.12. pg 11. <br />EPA Form 3320 -1 (Rev.01106) Previous editions may be used. 05/08/2013 Page 4 <br />