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PARAMETER <br />I cerotj under penalty of law that Ihu dowment and all attahments were prepared under my dneclton or <br />sup•rvtston in accordance with a sy m m designed to assure that qualified personnel properly gather and <br />on submed Based on my inquiry of the person or persons who manage the <br />ealuale the mfonnan in <br />system or those persons dvicelly r p nsIble for gathenne the mfnm,anon the mfomianun submitted is <br />to the best of my knowledge and better, true, accurate, and complete I am °wale that there arc significant <br />penalties tor suhmittnie false niformation, including the posstbility ot fine and imprisonment for knim mg <br />violanons <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 />pH SAMPLE <br />00400 1 0 <br />Effluent Gross <br />MEASUREMENT <br />AREA Code <br />« « « « «« <br />- -- <br />MM /DD/YYYY <br />« « «..« <br />TYPED OR PRINTED <br />PERMIT <br />REQUIREMENT <br />6 5 <br />MINIMUM <br />9 <br />MAXIMUM <br />SU <br />Monthly <br />GRAB <br />Solids, settleable <br />0054510 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />« « « « «« <br />« « «. «« <br />« « « « «« <br />PERMIT <br />REQUIREMENT <br />5 <br />DAILY MX <br />mL/L <br />Monthly <br />GRAB <br />Oil and grease <br />0358210 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />« « « « «« <br />. « « «,. <br />«_ « «.« <br />- -- <br />« « « « «« <br />PERMIT <br />REQUIREMENT <br />10 <br />INST MAX <br />mg /L <br />Contingent <br />GRAB <br />Flow, in conduit or thru treatment plant <br />50050 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />« « « « «« <br />« « « « «. <br />PERMIT <br />REQUIREMENT <br />Req Mon <br />30DA AVG <br />Req Mon <br />DAILY MX <br />Mgal O <br />Monthly <br />INSTAN <br />Solids, total dissolved <br />70295 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />« «. « «« <br />« « « « «« <br />PERMIT <br />REQUIREMENT <br />QRTR AVG <br />R MAX <br />QRTR <br />mg /L <br />Quarterly <br />GRAB <br />Oiland grease visual <br />840661 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />« «a « «a <br />...,., <br />« «, « «« <br />, « « « «« <br />« « «... <br />PERMIT <br />REQUIREMENT <br />Req Mon <br />INST MAX <br />'r =1 N =0 <br />Monthly <br />VISUAL <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICE <br />I cerotj under penalty of law that Ihu dowment and all attahments were prepared under my dneclton or <br />sup•rvtston in accordance with a sy m m designed to assure that qualified personnel properly gather and <br />on submed Based on my inquiry of the person or persons who manage the <br />ealuale the mfonnan in <br />system or those persons dvicelly r p nsIble for gathenne the mfnm,anon the mfomianun submitted is <br />to the best of my knowledge and better, true, accurate, and complete I am °wale that there arc significant <br />penalties tor suhmittnie false niformation, including the posstbility ot fine and imprisonment for knim mg <br />violanons <br />TELEPHONE <br />DATE <br />_ - -. ---- <br />// [ / — � <br />/ 4 P �/ .' ''1----,,------- <br />1 <br />j <br />"`J ✓ <br />, (4A ( - {..� V �i l I e P iC n <br />�, 70 <br />�"7 t � ' 7 J ' , <br />`. <br />(+ G_(r / <br />�/ <br />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 />/0 /Cr /ac <br />(I <br />011 -A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY MM /DD/YYYY <br />TO / L /.3/ /2k,(( <br />Form Approved <br />OMB No 2040 -0004 <br />DMR Mailing ZIP CODE: 80467 -9704 <br />MINOR <br />(SUBR JC) MOFAT <br />NWNE 6 5N-91W TO WILLIAMS FORK <br />External Outfall <br />No Discharge <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />SETTLEABLE SOLIDS LIMIT WAIVED FOR >10YR,24HR PRECIP EVENT -SEE I.A.1,PG. 3 FOR REQUIREMENTS OIL &GREASE GRAB SAMPLE ANALYSIS REQUIRED IF VISIBLE SHEEN IS OBSERVED QRTRLY SAMPLING <br />INSTRUCTIONS -I C.12,PG. 9. <br />01/11/2012 Page 1 <br />