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PARAMETER <br />I certify under penalty of low that thus document and all attachments were prepared under ml direction or <br />supemston m accordance with a system designed to assure tMt qualified personnel properly gather and <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />E)( <br />FREQUENCY <br />OF ANALYSIS <br />SAMPLE <br />TYPE <br />VALUE <br />VALUE <br />UNITS <br />VALUE <br />VALUE <br />VALUE <br />UNITS <br />Oil and grease visual <br />84066 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />. * *... <br />— <br />-- <br />* *• * *• <br />* * " * ** <br />* * "` ** <br />NO <br />p 15C�'IAQ <br />C <br />PERMIT <br />REQUIREMENT <br />* "•** <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />* * * * "* <br />" "" <br />Twice Per <br />Month <br />VISUAL <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER <br />I certify under penalty of low that thus document and all attachments were prepared under ml direction or <br />supemston m accordance with a system designed to assure tMt qualified personnel properly gather and <br />/ <br />TELEPHONE <br />DATE <br />V <br />Dfr Bb Q/� 27 4 i D 6 PC - S � - C FO <br />I t th mi t bur n d. a d v um iry f th pe n pe h inn g the <br />system, or those persons directly responsible for gathenng the infnrmahon, the information submitted is <br />to the bat aims knowledge and belief, true, accurate. and complete I am aware that them ore s f <br />penalties for subm hmg false n[o motion, t cludmg he possibility of f e and imprisonment em for blowing <br />notations <br />j <br />/ -.ell -.ell ( / / � <br />� ✓ " <br />3 3 p 1 <br />1.J -��1 <br />O 2 <br />e �� <br />— O� <br />SIGNATURE OF PR CIPAL EXECUTIVE O R 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: Chevron Mining Inc <br />ADDRESS: 116 Inverness Dr E Ste 207 <br />Englewood, CO 80112 <br />FACILITY: EDNA MINE <br />LOCATION: 26990 COLORADO HWY 131 <br />OAK CREEK, CO 80467 <br />ATTN: Jim Tarazoff, Land Mgr <br />EPA Form 3320 -1 (Rev.01 106) Previous editions may be used. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />FROM <br />C00032638 <br />PERMIT NUMBER <br />004 -A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD /YYYY <br />07/01/2012 <br />MM /DD/YYYY <br />07/31/2012 <br />TO <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />SETTLEABLE SOLIDS LIMIT WILL BE WAIVED FOR >10YR,24HR PRECIP EVENT - SEE I.A.2, PG. 4 FOR REQUIREMENTS.QRTRLY SAMPLING INSTRUCTIONS - I.C.10, PG. 9. <br />DMR Mailing ZIP CODE: 80112 <br />MINOR <br />Form Approved <br />OMB No. 2040 -0004 <br />ROUTT <br />SURFACE RUNOFF TO TROUT CREEK <br />External Outfall <br />No Discharge <br />07/30/2012 Page 2 <br />