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PARAMETER <br />1 cerufv under penalty of law that tilts document and all attachments were prepared under my gat dnecnnn or <br />.up.rnun t m .11,0(d., with a wuem d. >,gned to a»ar. r> that qualified pe nutd pn'1`ir) h., and <br />11 th • 1 nn t hn y rt U t y ry fib p t r p I u th <br />u.m or those mum.. dun. ry n >ponct hlc tot gathennS rile un( men.m the information whmnnJ u. <br />its tilt N. ul my knuwl.dgt and Kl .l tnu a.turnt and complct. I am a..are that th..n n. ugnuli.an <br />penulnc.for>ubmituny false mfrmauon mtludmg ih. po.ubeev of lin and umpnwnment for kno�� m <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 />AREA Code I NUMBER <br />M <br />D(YYYY <br />PERMIT <br />REQUIREMENT <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />'°•" <br />•'•"' <br />1 tl 1 Y <br />Twice Per <br />Month <br />VISUAL <br />NAMEfrITLE PRINCIPA EXECUTIVE OFFICER <br />1 cerufv under penalty of law that tilts document and all attachments were prepared under my gat dnecnnn or <br />.up.rnun t m .11,0(d., with a wuem d. >,gned to a»ar. r> that qualified pe nutd pn'1`ir) h., and <br />11 th • 1 nn t hn y rt U t y ry fib p t r p I u th <br />u.m or those mum.. dun. ry n >ponct hlc tot gathennS rile un( men.m the information whmnnJ u. <br />its tilt N. ul my knuwl.dgt and Kl .l tnu a.turnt and complct. I am a..are that th..n n. ugnuli.an <br />penulnc.for>ubmituny false mfrmauon mtludmg ih. po.ubeev of lin and umpnwnment for kno�� m <br />/ <br />t !e( <br />` <br />TELEPHONE <br />DATE <br />JAW �/ <br />C <br />C hvc <br />e I <br />1.1l cs <br />YV ll <br />ter) <br />9/6 .- 7b9- d Q (O <br />Q //tl <br />2.Q / -2.— <br />GNATURE OF PRINCIP EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />. <br />TYPED OR PRI <br />ED <br />( <br />AREA Code I NUMBER <br />M <br />D(YYYY <br />PERMITTEE NAME /ADDRESS (include FacddyName /Locahon,(Different) <br />NAME: Terror Creek LLC <br />ADDRESS: 43440 Bowie Rd <br />Paonia, CO 81428 <br />FACILITY: TERROR CREEK LOADOUT <br />LOCATION: 43440 BOWIE ROAD <br />PAONIA, CO 81428 <br />ATTN: JAMES T. COOPER, PRESIDENT <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 />COG850028 <br />PERMIT NUMBER <br />002A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />10/01/2011 <br />MM/DD/YYYY <br />12/31/2011 <br />TO <br />DMR Mailing ZIP CODE: 81428 <br />MINOR <br />Form Approved <br />OMB No 2040 -0004 <br />DELTA <br />DUGOUT POND TO N FORK GUNNISON <br />External Outfall <br />No Discharge <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />SETTLEABLE SOLIDS LIMIT WAIVED FOR10 -YR, 24 HR PRECIP EVENT SUBJECT TO BURDEN OF PROOF REQUIREMENTS INPART I B 6. ANY ADDITIONAL DATA SHALL BE SUPPLIED TO THE DIVISION WITHIN 48 HOURS. <br />Page 2 <br />