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PARAMETER <br />I randy under penalty of law that this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualified personnel properly gather and <br />valuate the information submitted Based on my mqutry of the person or persons who manage the <br />system or those person directly sp nstble for gathering the information, the information submitted is, <br />to the kcal of my knowledge and belief, true, accurate, and complete 1 am aware that there are stg leant <br />penahuntorsubm tnmgtalmemrormaeon, maudingtheposstbdtryettineand�mpr „m,memforknowmg <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 />O il and grease visual <br />84066 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />,,,,,, <br />/ <br />l <br />t,,,,, <br />• *•• ** <br />*•• *•� <br />, ,,, <br />Q <br />�7 <br />,S ` r, <br />PERMIT <br />REQUIREMENT <br />Req. Mon. <br />INST MAX <br />Y=1;N=0 <br />Weekly <br />VISUAL <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />I randy under penalty of law that this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualified personnel properly gather and <br />valuate the information submitted Based on my mqutry of the person or persons who manage the <br />system or those person directly sp nstble for gathering the information, the information submitted is, <br />to the kcal of my knowledge and belief, true, accurate, and complete 1 am aware that there are stg leant <br />penahuntorsubm tnmgtalmemrormaeon, maudingtheposstbdtryettineand�mpr „m,memforknowmg <br />a <br />A // � V ( /J <br />+<- if / �_ <br />7 <br />TELEPHONE <br />DATE <br />� f C (C t ` L GL � f S r <br />Cif <br />7 C G 7Ct ` 7 C^ <br />1 L <br />r ( / <br />` C. / <br />1 / <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />AREA Code ( NUMBER <br />MM /DDIYYYY <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 />000034142 <br />PERMIT NUMBER <br />024 -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 />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 />Form Approved <br />OMB No. 2040 -0004 <br />DMR Mailing ZIP CODE: 80467 -9704 <br />MINOR <br />(SUBR JC) MOFAT <br />DEWATER MINE 5 TO WLLMS FORK R <br />External Outfall <br />No Discharge <br />01/11/2012 Page 2 <br />