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PERMITTEE NAME/ADDRESS (Include Facr/ityName/Locafon ifDifeient) <br />NAME: <br />ADDRESS: <br />Bowie Resources LLC <br />PO Box 483 <br />Paonia, CO 81428 <br />FACILITY: BOWIE NO.2 MINE <br />LOCATION: 5 MI NE OF TOWN ON CO HWY 133 <br />PAONIA, CO 81428 <br />ATTN: BRADLEY E. HANSON, VICE PRES. <br />Oil and grease visual <br />84066 1 0 <br />Effluent Gross <br />PARAMETER <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />TYPED OR PRINTED <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />EPA Form 3320 - 1 ( Previous editions may be used. <br />VALUE <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />FROM <br />C00044776 <br />1 <br />PERMIT NUMBER <br />003A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MMIDDIYYYY <br />MMIDD/YYYY <br />..09/20/2G0. <br />b6- of - /r <br />QUANTITY OR LOADING <br />VALUE <br />MAX <br />INS X <br />UNITS <br />• <br />Y =1;N=0 <br />TO <br />1 comfy order penalty of law that this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualified pennon' properly gather and <br />evaluate the information submitted. Based m my inquiry of the person or persons who manage the <br />system, or those persons directly responsible for gathering she infonmutiiom. the information submitted is. <br />to the best of my koowlcdge and behef true. accurate. and �s l am aware that there am significant <br />penalties for sabminiug fake tote masims including the posa of fine end imprisonment for blowing <br />violations. <br />6C -30•/ <br />VALUE <br />QUALITY OR CONCENTRATION <br />VALUE <br />VALUE <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />DMR Mailing ZIP CODE: 81428 <br />MINOR <br />(SUBR MH) DELTA <br />SR;DEER TRL DTC OR UNMD TRIB <br />External Outfall <br />UNITS <br />IMO *V <br />NO. <br />EX <br />FREQUENCY <br />OF ANALYSIS <br />Form Approved <br />OMB No. 2040 -0004 <br />No Discharge <br />DATE <br />AREA Code NUMBER MMIDD/YYYY <br />SAMPLE <br />TYPE <br />VISUAL <br />70.q s 0222 -/I <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />SETTLEABLE SOLIDS LIMIT APPLIES ONLY IF <= 10YR,24HR PRECIP EVENT IS CLAIMED. IF CLAIM APPROVED BY WQCD,TSS & IRON LIMITS WILL NOT BE APPLIED TO REPORTED MEASUREMENTS -SEE I.A.3, PP 4-5 FOR <br />BURDEN OF PROOFREQUIREMENTS. OIL & GREASE-1.6.1.E, PG 9. QRTRLY SAMPLING INSTRUCTIONS- I.C.10, PG. 10. <br />Page 2 <br />