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PERMITTEE NAME/ADDRESS (include Facility Name&ocation if Different) <br />NAME: Terror Creek LLC <br />ADDRESS: 43440 Bowie Rd <br />Paonia, CO 81428 <br />FACILITY: TERROR GREEK 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 002-A <br />PERMIT NUMBER 1 DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM/DD/YYYY MMIDD/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 />DUGOUT POND TO N FORK GUNNISON <br />External Outfall <br />No Discharge 1-1711 <br />PARAMETER <br />I certify under penalty of law that 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 persona who manage the <br />system, or those persons directly responsible for gathering the information, the information submitted Is, <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 />> <br />TYPED OR PRINTED <br />*****^ <br />**«**^ <br />*•••«« <br />*^•••* <br />PERMIT <br />REQUIREMENT <br />^^*^^* <br />Req. Mon. <br />INST MAX <br />Y=1;N=0 <br />I <br />****** <br />****** <br />****^* <br />****** <br />Twice Per <br />Month <br />VISUAL <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />I certify under penalty of law that 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 persona who manage the <br />system, or those persons directly responsible for gathering the information, the information submitted Is, <br />•- " ' j i I ` - <br />TELEPHONE <br />DATE <br />to the best of my knowledge and bell.[ true, accurate, and complete. I am aware that there are <br />T I <br />significant penalties for submitting false Information, Including the possibility of fn. and Imprisonment for <br />SIGNATURE OF INCIPAL EXECUTIVE OFFICER OR <br />j 9 SOV <br />> <br />TYPED OR PRINTED <br />knowingviotatlons. <br />AUTHORIZED AGENT <br />AREA Code NUMBER <br />MW0D;rNw <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />SETTLEABLE SOLIDS LIMIT WAIVED FOR10-YR, 24 HR PRECIP EVENT SUBJECT TO 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 />