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PARAMETER <br />1 certify under penalty of law that this document and all attachments were Prepared under my direction or <br />supervision inaccordanmwith as yt emdesignedtosm ote thatqu alifiedpersonnelprope rlygatherand <br />' "nod <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />z <br />z <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 />a..... <br />PERMIT <br />REQUIREMENT <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />a "'aa <br />Monthly <br />VISUAL <br />• E/TITLEPRIN PAL ECUTIVEOFFICE <br />1 certify under penalty of law that this document and all attachments were Prepared under my direction or <br />supervision inaccordanmwith as yt emdesignedtosm ote thatqu alifiedpersonnelprope rlygatherand <br />' "nod <br />4.4 e c f <br />TELEPHONE <br />DATE <br />W. _, <br />' / ` • <br />I t the nt sub B d my inquiry of the person ur persons who manage the <br />system, or dime persons dirccdy responsible for gathering the infoadinformation <br />on, me submitted is. <br />so the beat of my knowledg and belief, true, accurate, and complete. I am aware that there arc significant <br />penalties for submitting faire information including the possibility of feandimprisonmentherkmswin <br />q ?a - �z�� <br />�a f y2.0 , / <br />M YYYY <br />1 .0 <br />IGNATUREOFPRIN AL EXECUTIVE OFFICER OR RI <br />AUTHOZED AGENT <br />AREACode 1 NUMBER <br />TYPED O PRINTED <br />PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME: Oxbow Mining LLC <br />ADDRESS: PO Box 535 <br />Somerset, CO 81434 -0535 <br />FACILITY: <br />LOCATION: <br />SANBORN CRK & ELK CRK MINES <br />3737 HIGHWAY 133 <br />SOMERSET, CO 81434 <br />ATTN: James T. Cooper, EVP <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 />C00000132 <br />PERMIT NUMBER <br />017 - A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />09/01/2011 <br />MM /DD/YYYY <br />09/30/2011 <br />TO <br />DMR Mailing ZIP CODE: 81424 -0535 <br />MINOR <br />GUNIS <br />SURF RUNOFF TO N. FK GUNIS RIV <br />External Outfall <br />Form Approved <br />OMB No. 2040-0004 <br />No Discharge <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />TSS & TOTAL IRON LIMITS WILL BE WAIVED, AND SETTLEABLE SOLIDS LMT APPLIES FOR <= 10YR,24HR PRECIP EVENT :SETTLEABLE SOLIDS LIMIT MAY BE WAIVED FOR >10YR,24HR EVERT -SEE IA1,PP 4 - AND IA.2., P 5 <br />FOR RQMNTS. TDS MONITORING - SEE PART VI.A.2.G OF RATIONALE. 30 DAY AVG IS HIGHEST MONTHLY AVG. DURING PERIOD RPTD <br />Page 2 <br />