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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, Sup <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />C00034142 022 -A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY I MM /DD/YYYY <br />1/1/2015 3/31 /2015 <br />Form Approved <br />OMB No. 2040 -0004 <br />DMR Mailing ZIP CODE: 80467 -9704 <br />MINOR <br />Spoils Springs to Channel Prior to Discharge to Wlllia <br />External Outfall <br />No Discharge EJ <br />PARAMETER <br />Icw* under malty of law inat the document and am attachments were prepared under my &act -or <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 />C� <br />V G`�`} v4 <br />"'••• <br />" " " "' <br />••• "' <br />' " "•' <br />�) <br />�� <br />�/ <br />V,S l <br />PERMIT <br />REQUIREMENT <br />"' "`" <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />"'.'• <br />e• "" <br />a " " "" <br />" * "" <br />Twice Per <br />Month <br />VISUAL <br />NAME IrITLE PRINCIPAL EXECUTIVE OFFICER <br />Icw* under malty of law inat the document and am attachments were prepared under my &act -or <br />TELEPHONE DATE <br />su perns'wn in accordance mth a system designed to amre that qualified personnel property gamer and <br />%aInformation hele the Info subrmtted. eased on my Inquiry of the person or persons who manage the <br />L( r <br />,/� <br />xv/7 <br />system or those persons duecty responsible for gathering the Information. de Information submmed is. <br />b the beet of my knowledge and beref. W . eaurale. and complete. I am aware that there are <br />]f� —(-! y y T n /f <br />01-74 70 z%� <br />/ <br />slgnifcaq penaftes for wwnftUng false inramhatan. iodmg the possiary or fine and Imprisonment for <br />"0fo�• <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />V G`�`} v4 <br />TYPED OR PRINTED <br />AREA Coda <br />NUMBER MMIDDIYYYY <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 />EPA Form 3320 -1 (Rev.01 /06) Previous editions may be used. 05/08/2013 Page 4 <br />