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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME: Terror Creek LLC <br />ADDRESS: 43440 Bowie Rd <br />Paonia. CO 81428 <br />FACILITY: TERROR CREEK LOADOUT <br />LOCATION: 43440 BOWIE ROAD <br />PAONIA, CO 81428 <br />ATTN: JAMES T. COOPER, PRESIDENT <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />COG850028 I I001 -A <br />PERMIT NUMBER I I DISCHARGE NUMBER <br />MONITORING PERIOD <br />MWDD/YYYY MM/DD/YYYY <br />07/01/2015 09/30/2015 <br />Form Approved <br />OMB No. 2040.0004 <br />DMR Mailing ZIP CODE: 81428 <br />MINOR <br />DELTA <br />SEDI POND #1 TO N FORK GUNNISN <br />External Outfall <br />No Discharge <br />PARAMETER <br />I certify under penalty of Wwthat this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualified personnel property 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 />to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are <br />signmcant penalties for submitting false information. including the possibility of fine and imprisonment for <br />knowing violations. <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 />840661 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />'**"*' <br />PERMIT <br />REQUIREMENT <br />«*'*'* <br />Req. Mon. <br />INST MAX <br />Y=1;N=0 <br />I <br />**««"« <br />I <br />«'«*** <br />****«* <br />*«'*** <br />I <br />Twice Per <br />I Month <br />VISUAL <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />I certify under penalty of Wwthat this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualified personnel property 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 />to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are <br />signmcant penalties for submitting false information. including the possibility of fine and imprisonment for <br />knowing violations. <br />TELEPHONE <br />DATE <br />_. _ .. <br />TYPED OR PRINTED <br />, . - • • ` <br />r ' - '�,- <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />ABEA code NUMBER <br />MMIDd/YY`rY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />SETTLEABLE SOLIDS LIMIT WAIVED FOR10-YR, 24 HR PRECIPT EVENT SUBJECTTO BURDEN OF PROOF REQUIREMENTS INPART 1.B.6. ANY ADDITIONAL DATA SHALL BE SUPPLIED TO THE <br />DIVISION WITHIN 48 HOURS. <br />EPA Form 3320-1 (Rev.01/06) Previous editions may be used. 04/10/2014 Page 2 <br />