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PERMITTEE NAME/ADDRESS (Include Facility Name/Location 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- Scott Cowman, Sr Env Spec <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />COG850008 001-A <br />PERM T NUMB R I DISCHARGE N MBER <br />MONITORING PERIOD <br />MM/DD/YYYY MM/DD/YYYY <br />07/01/2015 09/30/2015 <br />Form Approved <br />OMB No 2040-0004 <br />DMR Mailing ZIP CODE: 81639 <br />MINOR <br />ROUTT <br />POND (SW/4) TO DRY CRK/YAMPA <br />External Ouffall <br />No Discharge P j <br />PARAMETER <br />1 cemfy under penalty of law that this document and all attachments were prepared under my chrect on 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 />840661 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />****** <br />****** <br />****** <br />«**«** <br />«***** <br />TYPED OR PRINTED <br />AREA Code I NUMBER <br />M DD <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 />NAMEIIITLE PRINCIPAL EXECUTIVE OFFICER <br />1 cemfy under penalty of law that this document and all attachments were prepared under my chrect on or <br />I <br />TELEPHONE <br />DATE <br />supe nasion in accordance wth a system designed to assure that qualified personnel properly gather and <br />valuate the information submitted Based on my Inquiry of the person or persons who manage thee <br />system or those persons directly responsible for gathering the information, the information submittd is <br />d is <br />f ^+ <br />"" L <br />( <br />to the best of my knowledge and belief, true, accurate, and complete I am aware that there are s" t <br />fine for knownng <br />SIGNATURE OF PRINCI AL EXECUTIVE OFFICER OR <br />�( U fy <br />penalties for submiflmg false information Including the possibility of and imprisonment <br />violations <br />AUTH91RIZED AGENT <br />S 7ILI <br />s <br />TYPED OR PRINTED <br />AREA Code I NUMBER <br />M DD <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 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. 04/20/2015 Page 1 <br />