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PARAMETER <br />1 certify under penalty or law that flits document and all anachments were prepared under me direction or <br />und super. ntoninaccordancexilhasrrtemdesigedtoassurethatqualified personnelpn perlygntherarvl <br />evaluate the information submitted directly . Based on my inquiry of the person or persons who manage the <br />system. ur those persons direct responsible for gathering the information, the mf munon submitted u. <br />to the hest of on knowlNge end d belief, true. eccmate, and complete. I am aware that there are significant <br />for suhminm f rma <br />alse infotian, inchdmg the povnbdiry of fine and impn> for kmrwmg <br />pemlfo " <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 />84066 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />D <br />. „ „e <br />.e „., <br />e „.„ <br />I L d <br />I.S <br />S <br />PERMIT <br />RE <br />REQUIREMENT <br />" ”" <br />Reeqq. Mon. <br />INST MAX <br />Y :N=0 <br />1 <br />_ <br />*"”' <br />„"”' <br />""”' <br />Monthly <br />VISUAL <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICE <br />1 certify under penalty or law that flits document and all anachments were prepared under me direction or <br />und super. ntoninaccordancexilhasrrtemdesigedtoassurethatqualified personnelpn perlygntherarvl <br />evaluate the information submitted directly . Based on my inquiry of the person or persons who manage the <br />system. ur those persons direct responsible for gathering the information, the mf munon submitted u. <br />to the hest of on knowlNge end d belief, true. eccmate, and complete. I am aware that there are significant <br />for suhminm f rma <br />alse infotian, inchdmg the povnbdiry of fine and impn> for kmrwmg <br />pemlfo " <br />CM <br />TELEPHONE <br />DATE <br />7 - 20 w„ t 1 <br />SIGNATURE `1F PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />111 <br />A REA c oda I NUMBER <br />1 <br />MM/DD/YYYY <br />TYPED OR PRINTED <br />PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME: Sage Creek Coal Company LLC <br />ADDRESS: 29515 Routt CR 27 <br />Oak Creek, CO 80467 <br />FACILITY: SAGE CREEK MINE COMPLEX <br />LOCATION: 36600 CR 27 <br />HAYDEN, CO 81639 <br />ATTN: Mike Ludlow, GM <br />Qgnnss Jones <br />• ) 276 -5209 <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />Settleable solids limits waived for >10YR,24HR precip event subject to burden of proof in I.A.2. Quarterly monitoring - see C.10, pg 10. <br />EPA Form 3320 -1 (Rev.01/06) Previous editions may be used. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />FROM <br />C00048275 <br />PERMIT NUMBER <br />004-A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />04/01/2011 <br />MM/DD/YYYY <br />06/30/2011 <br />TO <br />DMR Mailing ZIP CODE: 80467 <br />MINOR <br />ROUTT <br />Discharge to Fish Creek <br />External Outfall <br />Form Approved <br />OMB No. 2040-0004 <br />No Discharge <br />Page 2 <br />