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NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) MINOR Form Approved <br />PERMITTEE NAME/ADDRESS (includes Facility Name/Location if Different) DISCHARGE MONITORING REPORT (DMR) (SUBR JC) OMB No. 2040-0004 <br />F - FINAL MOFFAT <br />NAME BTU EMPIRE CORPORATION - EAGLE MINE COMPLEX NO. 5 MINE TOM/ILLIAMS FK <br />ADDRESS 29515 RCR #27 000034142 003 A Check here if No Discharge <br />OAK CREEK, CO 80467 PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY LOCATION CRAIG, CO NOTE: Read Instructions before completing this form <br />ATTN: Mr. Jerry Nettleton, Environmental Supervisor <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />10 04 01 TO 10 06 30 <br /> QUALITY OR LOADING QUALITY OR CONCENTRATION FREQUENCY SAMPLE <br />PARAMETER <br />?E? <br />NO. <br />OF <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS <br />OIL AND GREASE SAMPLE .."`"' (94) ..... ...... ....,. <br />VISUAL _ MEASUREMENT O O 1n VISUAL <br />84066 1 0 0 PERMIT '"'" REPORT YES = 1 `.. .....« ...... .... <br />EFFLUENT GROSS VALUE REQUIREMENT INST MAX NO=0 WEEKLY VISUAL <br /> SAMPLE ...... ...... ...... .. .... ...... <br /> MEASUREMENT <br /> PERMIT ....., ...... ....» «..... ...... ... <br /> REQUIREMENT - <br /> SAMPLE .,,.., ...... ...... ...... ...... <br /> MEASUREMENT <br /> PERMIT .,...« .....« .,.... ....«. ., ...« .«.... <br /> REQUIREMENT <br /> SAMPLE ...... ....., ..«... <br /> MEASUREMENT <br /> PERMIT .,.... ...... ...... ...... ...... ..«« <br /> REQUIREMENT <br /> SAMPLE ...... ....., ,..,.« .. .,,. <br /> MEASUREMENT <br /> PERMIT ...,.,. ,..... ...... ...... ...... : ....... <br /> REQUIREMENT - <br /> SAMPLE ...... ....., ( 03) ..,,,. ...... ...... <br /> MEASUREMENT <br /> PERMIT ...... - ...... MGD ...... ....... ...... <br /> REQUIREMENT - - <br /> SAMPLE ,..... ...... ...,.. ...... ...... <br /> MEASUREMENT <br />1 <br /> PERMIT ...... .«... ....., ..«... «. .... ,...,..-. <br /> <br />REQUIREMENT 1 <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I Certify under penalty of law that this document and all attachments were prepared under TELEPHONE DATE <br /> my direction or supervision in accordance with a system designed to assure that qualified _ <br />Brian A. W atterson, P.G. personnel properly gather and evaluate the information submitted. Based on my inquiry of 970 870 - 2750 r? -7 <br />G <br />i <br />t <br />G <br />l th <br />r <br />r <br />h <br />th <br />t <br />th <br />di <br />l <br />ib <br />f SIGNATURE OF PRINCIPAL V ` <br />eo <br />og <br />s e person o <br />pe <br />sons w <br />o manage <br />em, or <br />e sys <br />ose persons <br />rect <br />y respons <br />le <br />or <br /> gathering the information, the information submitted is, to the best of my knowledge and belief, OFFICER OR AUTHORIZED AGENT AREA CODE NUMBER YEAR MO DAY <br /> true, accurate, and complete. I am aware that there are significant penalties for submitting <br />TYPE OR PRINTED false information, including the possibility of fine and imprisonment for knowing violations. <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />Flow limit applies to combined flow from 003, 022, & 024. Oil & Grease grab sample analysis required if visible sheen is observed. Quarterly sampling instructions - I.C.12, PG. 9. <br />EPA Form 3320-1 (REV 3/99) Previous editions may be used THIS IS A 4-PART FORM PAGE 2 OF 2