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PARAMETER <br />I certify under penalty of law that this document and all attachments were prepared under my direction or <br />‘upervrs, n,n accordance with a stem designed assure that qualnfied personnel properly gather and <br />ry m <br />evaluate the mfonnenon submitted Based on my inquiry of the person or persons who manage the <br />system, or throe persons directly responsible for gathering the mformaoon the information submitted in <br />to the best of my knowledge and belief, true, accurate, and complete lam aware that there are significant <br />penues <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 />NUMBER <br />MMIDDIYYYY <br />...... <br />....a. <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 />PERMIT <br />REQUIREMENT <br />.5 <br />DAILY MX <br />mL/L <br />Monthly <br />GRAB <br />OH and grease <br />0358210 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <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 />500501 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />. nisi , <br />,,,,,, <br />PERMIT <br />REQUIREMENT <br />Req Mon. <br />3ODA AVG <br />Req Mon <br />DAILY MX <br />Mgand <br />Monthly <br />INSTAN <br />Solids, total dissolved <br />702951 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />...... <br />.....< <br />,..... <br />,... <br />PERMIT <br />REQUIREMENT <br />Req Mon. <br />QRTR AVG <br />Req Mon <br />QRTR MAX <br />mg /L <br />Quarterly <br />GRAB <br />Oil and grease visual <br />84066 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />....., <br />...... <br />..,... <br />...... <br />PERMIT <br />REQUIREMENT <br />Req Mon <br />INST MAX <br />Y =1 N =0 <br />Monthly <br />VISUAL <br />NAMEfTITLE PRINCIPAL EXECUTIVE OFFICER <br />I certify under penalty of law that this document and all attachments were prepared under my direction or <br />‘upervrs, n,n accordance with a stem designed assure that qualnfied personnel properly gather and <br />ry m <br />evaluate the mfonnenon submitted Based on my inquiry of the person or persons who manage the <br />system, or throe persons directly responsible for gathering the mformaoon the information submitted in <br />to the best of my knowledge and belief, true, accurate, and complete lam aware that there are significant <br />penues <br />' <br />TELEPHONE <br />DATE <br />R �— <br />l J / ,- f_,....� <br />C (' f / <br />J <br />(,t <br />I <br />l <br />` , YJL1� <br />q 70 <br />7 �,�' <br />, L [_„ 'Z C' <br />G' / `� z <br />r <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />AREA Code <br />NUMBER <br />MMIDDIYYYY <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 (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 />/ o /o 1 J k II <br />012 -A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM/DDIYYYY <br />TO L f a /'3( /� t <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.0 12,PG. 9. <br />01/11/2012 Page 1 <br />