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PERMITTEE NAME/ADDRESS (Include Facility Name/Location d Ddfererro-- <br />NAME: Moffat o�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, Supv <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />000034142 024-A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM/DD/YYYY MM/DD/YYYY <br />111/2017 3/3112017 <br />Form Approved <br />OMB No. 2040-0004 <br />DMR Mailing ZIP CODE: 80467-9704 <br />MINOR <br />Mine Dewatering to Sedimentation Basin Prior to Dist <br />External Outrall <br />No Discharge <br />LN <br />PARAMETER <br />icaddy tdte,pdhn'yoflaw ttWind,dodde"amand aO"'nmclieehdpd,pa.edued,� dihVon_I( <br />-P.-.— In aecard— wen a s, dsan deskpned to a-1. that dnah,ad Perssainei InWady gate., he <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 />W <br />TYPED OR PRINTED <br />'•"" <br />••"•• <br />"" <br />a"'•' <br />PERMIT <br />REQUIREMENT <br />"e"` <br />Req. Mon. <br />INST MAX <br />Y=1;N=0 <br />I <br />""" <br />"e"' <br />""" <br />""" <br />Twice Per <br />Month <br />VISUAL <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER <br />icaddy tdte,pdhn'yoflaw ttWind,dodde"amand aO"'nmclieehdpd,pa.edued,� dihVon_I( <br />-P.-.— In aecard— wen a s, dsan deskpned to a-1. that dnah,ad Perssainei InWady gate., he <br />f <br />TELEPHONE <br />DATE <br />vaWete the hd—,i- SUMwtt.d e.s.d.n my'do. r, J en, red at v Persons whe manage in,„ <br />sys'em "dross persons d—dy reapotnlbi. to 9whenn9 tee nfa dod the nbrr�-nGrm suSmtt:ad a <br />w -he bestdt” k—madge.hd bww true eee—N and caa,iw.. dm.—. that M.ro me <br />- <br />j`` ,�.•.p L.� <br />�i1Ge� <br />//�� <br />R 7c) l0 l -^7 � <br />/// <br />%4I, C It -7 t-7 <br />Weil„ T <br />„9Nhc,mP.nwda.ra,uemin..gtaK.mmenwae ekwmothe Po..mervetr .ndlmmna,—lh. <br />naee� was eh. <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />11 / /V 4 <br />W <br />TYPED OR PRINTED <br />AREA cede NUMBER <br />MMIDOn'VYY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />Oil and grease sample required d visible sheen is observed. Qtrly sampling Instructions - LC.12, pg 11. <br />EPA Form 3320-1 (Rev.01106) Previous editions may be used. 05/08/2013 Page 4 <br />