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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 f with t system designed my i to assure oft qualified person ha gather and <br />ew*l* lu m the' formation submitted. Based inquiry iry ofiha o person who o manage the <br />to the system, b st thou persons directly responsible fMa . for or gathering the pet the e a in s that there submitted is, <br />m the best of my knowledge and belief, true, accurate, and compllete. e. I am information, , am aware that theeta w significant <br />penalties for submitting false information. including the possibility of fine and imprisonment for knowing <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 />.a.••• <br />.,.... <br />••a•.• <br />PERMIT <br />REQUIREMENT <br />•••••' <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />"•'•• <br />Weekly <br />VISUAL <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />1 certify under penalty of law that this document and all attachments were prepared under my direction or <br />supervision in f with t system designed my i to assure oft qualified person ha gather and <br />ew*l* lu m the' formation submitted. Based inquiry iry ofiha o person who o manage the <br />to the system, b st thou persons directly responsible fMa . for or gathering the pet the e a in s that there submitted is, <br />m the best of my knowledge and belief, true, accurate, and compllete. e. I am information, , am aware that theeta w significant <br />penalties for submitting false information. including the possibility of fine and imprisonment for knowing <br />violations. <br />"!fYJ <br />TELEPHONE <br />DATE <br />�- )�/7 y� y�,p , / <br />/ TY ! { ! (G ✓ <br />9 � � �� '<� <br />`� <br />It �� I ]/ <br />// <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />AREA Code NUMBER <br />MMIDD/YYYY <br />PED OR PRINTED <br />TYPED <br />PERMITTEE NAME/ADDRESS (/nclude Faci/ /tyName/Location ifDifferent) <br />NAME: <br />ADDRESS: <br />FACILITY: <br />LOCATION: <br />Bowie Resources LLC <br />PO Box 483 <br />Paonia, CO 81428 <br />BOWIE NO. 2 MINE <br />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 />FROM <br />000044776 <br />PERMIT NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />09/01/20 0 <br />MM /DD/YYYY <br />09/30/208@ <br />LC <br />002A <br />DISCHARGE NUMBER <br />TO <br />DMR Mailing ZIP CODE: 81428 <br />MINOR <br />(SUBR MH) DELTA <br />SR;DEER TRL DTC OR UNMD TRIB <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 />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- I.B.1.3, PG 9. QRTRLY SAMPLING INSTRUCTIONS- I.C.10, PG. 10. <br />Page 2 <br />