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PARAMETER <br />1 certify under penalty of law that this document and all attachments were prepared under my direhtmn or <br />,uperst>ton,n acsordanns with a system designed masenre that qualified personnel properly gather and <br />is aluate the information submitted Based on my inquiry of the p erson or persons who manage the <br />system, or tho se persons directly responsible for gathering the information, the information submitted u, <br />to the best of my know ledge and belief, true, acwrate, and complete I am aware that there are significant <br />fomation, cludmgthepusstbdtty offneandimpnunmenttorAnowmg <br />penalecsfursubmitting falsem m <br />I t 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 />0 11 and grease visual <br />84066 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />le***** <br />v <br />* * * * ** <br />l <br />l/ <br />y "7 <br />aS'� ` <br />ki it <br />***lc*. <br />* ** * ** <br />PERMIT <br />REQUIREMENT <br />* * ** ** <br />Req Mon <br />INST MAX <br />Y =1,N =0 <br />** * * ** <br />* * * *** <br />* * ** ** <br />•* * * *• <br />Twice Per <br />Month <br />VISUAL <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICE <br />1 certify under penalty of law that this document and all attachments were prepared under my direhtmn or <br />,uperst>ton,n acsordanns with a system designed masenre that qualified personnel properly gather and <br />is aluate the information submitted Based on my inquiry of the p erson or persons who manage the <br />system, or tho se persons directly responsible for gathering the information, the information submitted u, <br />to the best of my know ledge and belief, true, acwrate, and complete I am aware that there are significant <br />fomation, cludmgthepusstbdtty offneandimpnunmenttorAnowmg <br />penalecsfursubmitting falsem m <br />I t s <br />� r <br />` -` — <br />TELEPHONE <br />DATE <br />4,a c <br />, , { ,' t .� <br />// <br />', 6 V g <br />l V f �_ �•"'� <br />(j � yy� ••� ��� <br />!V <br />/ <br />/t T /. /r� <br />4� !!/ t ,. l / <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />AREA Code NUMBER <br />MM /DD/YYYY <br />TYPED OR PRINTED <br />PERMITTEE NAME /ADDRESS (Include Facility Name /Location if Different) <br />NAME: Twentymile Coal Co <br />ADDRESS: 29515 Routt CR 27 <br />Oak Creek, CO 80467 <br />FACILITY: <br />LOCATION: <br />FISH CREEK TIPPLE <br />29515 ROUTT COUNTY ROAD #27 <br />OAK CREEK, CO 80467 <br />ATTN JERRY N NETTLETON, ENV SUPVSR <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 />C00036684 <br />PERMIT NUMBER <br />001 -A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />MM /DD/YYYY <br />FROM 01/0'72012 <br />TO 4/02012 <br />DMR Mailing ZIP CODE: 80467 <br />MINOR <br />(SUBR JC) ROUTT <br />POND "E" DISCHARGE TO FISH CRK <br />External Outfall <br />Form Approved <br />OMB No 2040 -0004 <br />No Discharge <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />TSS LIMIT WILL BE WAIVED FOR 10YR,24HR PRECIP EVENT - SEE BURDEN OF PROOF REQUIREMENTS UNDER I.A 4, PG 5 OIL & GREASE - SEE I.B.2 30 DAY AVERAGE IS HIGHEST MONTHLY AVG. DURING PERIOD <br />REPORTED - SEE I C 13 <br />07/27/2011 Page 2 <br />