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PARAMETER <br />1 certify 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 lified personnel properly gather and <br />evaluate the information submitted Based on my inquiry of the person or persons who manage the <br />to the best of my fledge and belief, true. accurate, comple information, <br />e. a l am aware that there are significant <br />mlties for submitting false information including the possibility of <br />pe , f and imprisonment for knowing <br />n <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />O. <br />EX <br />FREQUENCY <br />OF ANALYSIS <br />SAMPLE <br />VALUE <br />VALUE <br />UNITS <br />VALUE <br />VALUE <br />VALUE <br />UNITS <br />LC50 Static Renewal 48Hr Acute <br />Ceriodaphnia dubia <br />TAM3B 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />...... <br />HMI. <br />""" <br />100.0001 <br />MN VALUE <br />"••" <br />""'• <br />% <br />Quarterly <br />GRAB <br />LC50 Statre 96Hr Acute Pimephales <br />TAN6C 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />• „••• <br />PERMIT <br />REQUIREMENT <br />—.•` <br />'••”' <br />" <br />100.0001 <br />MN VALUE <br />""" <br />" "" <br />% <br />Quarterly <br />GRAB <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICE <br />1 certify 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 lified personnel properly gather and <br />evaluate the information submitted Based on my inquiry of the person or persons who manage the <br />to the best of my fledge and belief, true. accurate, comple information, <br />e. a l am aware that there are significant <br />mlties for submitting false information including the possibility of <br />pe , f and imprisonment for knowing <br />n <br />TELEPHONE <br />DATE <br />�{ ,, /� �']/) <br />/ 1 • • e lu �ifn. <br />.b' _ _ f /_r. _l . <br />1111 ��� / / / /!!!!"'' C • <br />f � (, <br />gar WO/ <br />7 %72 <br />/ <br />MMIDD/YYYY <br />SIGNATURE OF P RINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />AREA Code <br />1 NUMBER <br />OR PRINTED <br />TYPED OR PRINTED <br />PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME: Trapper Mining Inc <br />ADDRESS: PO Box 187 <br />Craig, CO 81626 -0187 <br />FACILITY: TRAPPER MINE <br />LOCATION: 6.5 MI SW OT TOWN ON ST HWY 13 <br />CRAIG, CO 81625 <br />ATTN: Jim M. Mattem, Pres /GM <br />EPA Form 3320.1 (Rev.01106) Previous editions may be used. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />FROM <br />C00032115 <br />PERMIT NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />07/01/2011 <br />MM /DD/YYYY <br />09/30/2011 <br />0 <br />021 -W <br />DISCHARGE NUMBER <br />TO <br />is <br />DMR Mailing ZIP CODE: 81626 - 0187 <br />MINOR <br />MOFAT <br />WEST TESTING FOR 021A <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 />SEE 1A5, PP. 6.8, FOR DETAILS OFTEST PROCEDURE. REPORT LC50 - STATISTICAL POINT ESTIMATE WHICH ISLETHAL TO 50% OF TEST ORGANISMS, AND ATTACH ACUTE TOXICITY TEST REPORT FORM TO DMR. WHEN <br />WET TESTING NOTREQ'D, PUT NOT REQUIRED - SURFACERUNOFF ONLY" ON DMR. <br />06/02/2011 Page 1 <br />