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PARAMETER <br />1 certify under penalty of law that this document and all attachments were prepared under my dttedwn or <br />supervisionmaceomanee dhasyst emdestgnedtoassurethatquahficdpersonnelproperlygatherand <br />y inquiry of the person or peons who manage the <br />evaluate the information submuted Based on m ru <br />system or those persons directly resp stbie for gathering the Infornaron, the Informauon submnted Is <br />m the best of my knowledge and bch we, accurate, accurate, and complem m mendicant <br />am aware that there <br />n mt for subm, ltmgflse Information, including the posstbdd u <br />lute .r <br />}on m tor <br />p s <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 />Coliform, fecal general <br />7405510 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />,,,... <br />TYPED OR PRINTED <br />....,, <br />.,..,.. <br />PERMIT <br />REQUIREMENT <br />6000 <br />30DAVGEO <br />12000 <br />MX7DGEOA <br /># /100mL <br />Monthly <br />GRAB <br />Oiland grease visual <br />84066 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />.,,... <br />,,,,,, <br />.. >... <br />...,.. <br />...,.. <br />PERMIT <br />REQUIREMENT <br />" "" <br />Req. Mon <br />INST MAX <br />Y =1 N =0 <br />" ~' <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 dttedwn or <br />supervisionmaceomanee dhasyst emdestgnedtoassurethatquahficdpersonnelproperlygatherand <br />y inquiry of the person or peons who manage the <br />evaluate the information submuted Based on m ru <br />system or those persons directly resp stbie for gathering the Infornaron, the Informauon submnted Is <br />m the best of my knowledge and bch we, accurate, accurate, and complem m mendicant <br />am aware that there <br />n mt for subm, ltmgflse Information, including the posstbdd u <br />lute .r <br />}on m tor <br />p s <br />I- ? <br />/A Ct : e y' -� —� <br />TELEPHONE <br />DATE <br />I -{�_ <br />I 1 ti f1 JvCZ <br />0,-, <br />( 1 76 <br />! <br />��, �� <br />�, / G- '7 <br />I 2_,_ <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />AREA Code <br />NUMBER <br />MM /DD/YYYY <br />TYPED OR PRINTED <br />PERMITTEE NAME /ADDRESS (Include Facility Name /Location if Different) <br />NAME: Moffat County Mining LLC <br />ADDRESS: 29515 Routt CR 27 <br />Oak Creek, CO 80467 -9704 <br />FACILITY: <br />LOCATION: <br />EAGLE MINE COMPLEX <br />1030 COUNTY ROAD 107 <br />CRAIG, CO 81626 <br />ATTN: JERRY NETTLETON, ENV SUPERVISR <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 />C00034142 <br />PERMIT NUMBER <br />023 -A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />01/01/2012 <br />MM /DD/YYYY <br />03/31/2012 <br />TO <br />DMR Mailing ZIP CODE: 80467 -9704 <br />MINOR <br />(SUBR JC) MOFAT <br />DOM WW/WASHDOWN TO WILLIAMS FK <br />External Outfall <br />01/11/2012 <br />Form Approved <br />OMB No. 2040 -0004 <br />No Discharge <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />OIL & GREASE GRAB SAMPLE ANALYSIS REQUIRED IF VISIBLE SHEEN IS OBSERVED, IF NO CHLORINE WAS USED, REPORT"NCT" (NO CHLORINE TREATMENT). QRTRLY SAMPLING INSTRUCTIONS- I.C.12, PG 9. REPORT <br />INFLUENT SAMPLE ONDMR MARKED 3001. <br />Page 2 <br />