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PARAMETER <br />I tomb) under pomlty ot law that thudocument and all attachments were prepared under myduedronor <br />m o <br />supery n In a ordanbe with a system designed to assure that quahtl d personnel properly gather and <br />I t tl fo t o b u el B td y g ry ftl p rson o pe o ho mawge the <br />system or those persons directly responsible sible for gathering the information, the mformauon submitted is <br />to the best of my knowledge and belief, tr., accurate, and complete I am aware that there are significant <br />peohilon .ubmmmgtal mrnmatten, mewamgmepe, abdtryeune and rmpnsenm.ntmrw,ormg <br />a <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 />ON and grease visual <br />84066 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />l <br />,.,,., <br />6 <br />t <br />/� <br />i, �(- 4 <br />„aa„ <br />PERMIT <br />REQUIREMENT <br />Req Mon <br />INST MAX <br />Y =1 N =0 <br />Weekly <br />VISUAL <br />NAMEITITLEPRINCIPALEXECUTIVEOFFICER <br />I tomb) under pomlty ot law that thudocument and all attachments were prepared under myduedronor <br />m o <br />supery n In a ordanbe with a system designed to assure that quahtl d personnel properly gather and <br />I t tl fo t o b u el B td y g ry ftl p rson o pe o ho mawge the <br />system or those persons directly responsible sible for gathering the information, the mformauon submitted is <br />to the best of my knowledge and belief, tr., accurate, and complete I am aware that there are significant <br />peohilon .ubmmmgtal mrnmatten, mewamgmepe, abdtryeune and rmpnsenm.ntmrw,ormg <br />a <br />/ <br />^ � , - A <br />t J ,� �'" -_- <br />TELEPHONE <br />DATE <br />„j <br />r n ✓)�11^ <br />' �( r 7 C ` <br />J <br />/ <br />` n ; / /U / .. <br />�f <br />SIGNATU OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />AREA Code NUMBER <br />! <br />MMIDD/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 />MM /DD /YYYY <br />to /CI /0 <br />003 -A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />TO <br />MM /DD/YYYY <br />12 / t <br />Form Approved <br />OMB No. 2040 -0004 <br />DMR Mailing ZIP CODE: 80467 -9704 <br />MINOR <br />(SUBR JC) MOFAT <br />NO. 6 MINE TO WILLIAMS FORK RV <br />External Outfall <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />FLOW LIMIT APPLIED TO COMBINED FLOW FROM 003, 022 & 024. OIL & GREASE GRAB SAMPLE ANALYSIS REQUIRED IFVISIBLE SHEEN IS OBSERVED. QRTRLYSAMPLING INSTRUCTIONS- I.C.12, PG. 9. <br />No Discharge <br />01/11/2012 Page 2 <br />