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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 in accordance with a system designed to assure that qualified personnel properly gather and <br />or those persons directly responsible for gathering the information, the information submitted is. <br />system. othe of my w <br />o the best knowledge and belief, e, accurate, and complete. 1 am aware that there are s'g 'fevn <br />�t who manage the <br />pe A 1 11 . fo n t' s b 'n d B se I on 1 ry' q 'ry of the person or person nalties for submitting false information, including the possibility of fine and imprisonment for knowing ing lahons <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 />,...,, <br />apy� <br />C) <br />..,.., <br />,.,... <br />*,..,, <br />0 <br />As vie.i <br />–„— <br />PERMIT <br />REQUIREMENT <br />" "" <br />Req. Mon. <br />INST MAX <br />Y =1:N =0 <br />Twice Per <br />Month <br />VISUAL <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICE <br />1 certify under 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 personnel properly gather and <br />or those persons directly responsible for gathering the information, the information submitted is. <br />system. othe of my w <br />o the best knowledge and belief, e, accurate, and complete. 1 am aware that there are s'g 'fevn <br />�t who manage the <br />pe A 1 11 . fo n t' s b 'n d B se I on 1 ry' q 'ry of the person or person nalties for submitting false information, including the possibility of fine and imprisonment for knowing ing lahons <br />TELEPHONE <br />DATE <br />4 �/i- � . r� <br />��� .tea <br />l <br />� l _ _ �7 <br />,aJP �L <br />/ f t' {'J �r .( <br />( �" �^' , <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />A REA Code j <br />I NUMBER <br />f( / <br />MMIDDIYYYY <br />TYPED OR PRINTED <br />PERMITTEE NAME /ADDRESS (Include Facility Name /Location if Different) <br />NAME: Twentymile Coal Co <br />ADDRESS: 29515 Routt CR 27 <br />Oak Creek, CO 80467 <br />FISH CREEK TIPPLE <br />29515 ROUTT COUNTY ROAD #27 <br />OAK CREEK, CO 80467 <br />FACILITY: <br />LOCATION: <br />ATTN: JERRY N. NETTLETON, ENV SUPVSR <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 />C00036684 <br />PERMIT NUMBER <br />001 -A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />07/01/2011 <br />M M/D D /YYYY <br />09/30/2011 <br />TO <br />DMR Mailing ZIP CODE: 80467 <br />MINOR <br />(SURE JC) ROUTT <br />POND "E" DISCHARGE TO FISH CRK <br />External Outfall <br />Form Approved <br />OMB No. 2040 -0004 <br />No Discharger <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />TSS LIMIT WILL BE WAIVED FOR 10YR,24HR PRECIP EVENT - SEE BURDEN OF PROOF REQUIREMENTS UNDER I.A.4, PG 5.OIL & GREASE - SEE 1.0.2. 30 DAY AVERAGE IS HIGHEST MONTHLY AVG. DURING PERIOD <br />REPORTED - SEE I.C.13. <br />07/27/2011 Page 2 <br />