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PERMITTEE NAMEffi 06RESS (Include Facility Name/Location d Ddrerent) <br />NAME: <br />Moffat County Mining LLC <br />ADDRESS: <br />29515 Routt CR 27 <br />FREQUENCY <br />OF ANALYSIS <br />Oak Creek, CO 80467-9704 <br />FACILITY: <br />WILLIAMS FORK MINE <br />LOCATION: <br />1030 CR 107 <br />VALUE <br />CRAIG, CO 81626 -- <br />ATTN: Jerry Nettleton, Supv <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES: <br />DISCHARGE MONITORING REPORT (DMR) <br />000034142022-A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM/DD/YYYY MM/DD/YYYY <br />111/2017 3/31/2017 <br />Form Approved <br />OMB No. 2040.0004 <br />DMR Mailing ZIP CODE: 80467-9704 <br />MINOR <br />Spolls Springs to Channel Prior to Discharge to Willia <br />External Outfall <br />No Discharge <br />PARAMETER <br />waaw.bn m e[sq wNh a zvctnm eaalg tO easure that WOMm1 penonnM p'ODe"y gather aM <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 I <br />SAMPLE <br />MEASUREMENT <br />••'•^ <br />^-•• <br />••••^ <br />...... <br />•^" <br />p <br />' " <br />t <br />U, �l <br />PERMIT <br />REQUIREMENT <br />""•' <br />Req Mon. <br />INST MAX <br />Y=1;N-0 <br />I <br />""" <br />""" <br />"'•" <br />""" <br />I <br />Twice Per <br />Month <br />VISUAL <br />NAMEnME PRINCIPAL EXECUTIVE OFFICER <br />waaw.bn m e[sq wNh a zvctnm eaalg tO easure that WOMm1 penonnM p'ODe"y gather aM <br />TELEPHONE <br />DATE <br />(n' <br />W.— y 1 <br />ae:eletM iMamOlbn —.d, B.... On mYInOWry of mn porsonw Vetbne wtn manage <br />,y I—ag .persona da-ity--Obi. for gatnetag ihOmtamnWn, ttb lri—un fLemlaeC:a r_ <br />b me— d my arw•bAge eM fai t•.�n oCC�reb i rdhpbta I am mvere that mere ere <br />e'ar""^Unt nenoW.. ra>uem�mn taxa ato,mahon �ncWmne mo vm.�ary of nn. rine tmod:enmem mr 1, SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />p nMa.aana ii AUTHORIZED AGENT <br />, e <br />� ` ` ` �S�,'n <br />(� <br />q70 7o �J � <br />e] � (... <br />q " sl' <br />J <br />TYPED OR PRINTED <br />ARFA COAs I NUMBER <br />MMIUDM'VY <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.01106) Previous editions may be used. 05?08/2013 Page 4 <br />