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PARAMETER <br />Icen'f y under penalty of law that this document and all attachments were prepared under mydirectionor <br />supervision in accordance with a system designed to assure that qualified personnel properly gather and <br />evaluate the intoned submitted Based inquiry of the person persons who menage the <br />system, tem, or those persons ns directly responsible le for or gathering the informatioio n, the information submitted is, <br />to the best of knowledge and belief, tore, amore, and complete t am a that there are significant <br />penalties for submitting w false information, , including We possibility of fine and nd i e that t eat for l owing <br />violations. <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 />PERMIT <br />REQUIREMENT <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />" "'• <br />Weekly <br />VISUAL <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />Icen'f y under penalty of law that this document and all attachments were prepared under mydirectionor <br />supervision in accordance with a system designed to assure that qualified personnel properly gather and <br />evaluate the intoned submitted Based inquiry of the person persons who menage the <br />system, tem, or those persons ns directly responsible le for or gathering the informatioio n, the information submitted is, <br />to the best of knowledge and belief, tore, amore, and complete t am a that there are significant <br />penalties for submitting w false information, , including We possibility of fine and nd i e that t eat for l owing <br />violations. <br />/ <br />!' - 7' ////{]� <br />f 1 „ <br />TELEPHONE _ <br />DATE <br />f^ /f / <br />P Y , G '/ <br />//�� �� 9 qj 74's 1 5) <br />^ <br />b9 bah i <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />AREA Code NUMBER <br />MM/DD/YYYY <br />PED OR PRINTED <br />PERMITTEE NAME/ADDRESS (Include Faci/ityName/Location if Different) <br />NAME: Bowie Resources LLC <br />ADDRESS: 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 />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 />C00044776 <br />PERMIT NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />U9 /u IIG UU <br />MM /DD/YYYY <br />FROM <br />D61 i/ <br />009A <br />DISCHARGE NUMBER <br />TO K13130/2009 <br />4245. <br />I <br />Form Approved <br />OMB No. 2040-0004 <br />DMR Mailing ZIP CODE: 81428 <br />MINOR <br />(SUBR MH) DELTA <br />SR DSCH /UNNMD TRIB /HUBBARD CRK <br />External Outfall <br />No Discharge <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 RPTD MEASUREMENTS -SEE I.A.3,PG. 4-5 FOR BURDEN OF <br />PROOFREQUIREMENTS. OIL & GREASE - I.B.1.3, PG. 9. QRTRLY SAMPLING INSTRUCTIONS - I.C.10, PG. 10. <br />Page 2 <br />