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PARAMETER <br />I cendy under penalty of law that Bus document and all attachments were prepared under t dlrechon or <br />mpervenona accordance ttnhasynemdestgnedm assure that qunidiedpervonnelproperrly gather and <br />1 I the f t l tt d B d y guy f Ih pe pe h e• ih <br />+t stem, of tat person d a n d re llef,tue, forgmhcnn the I n thee thatthere are g vnbmn4J <br />to the e” of tat knowledge and mate true, accurate and ssatIt to I nm aware pro there t coot <br />perolhev for +ubrmtlmg lake mformohnn tncludmg the pasvtbddy of fine and tmpmm�ment far lnowmg <br />y, l t <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 />Oil and grease visual <br />84066 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />*. *..* <br />TYPED OR PRINTED <br />* " „„ <br />* * * * ** <br />, * *,,, <br />PIp <br />D(a.M <br />2.GE. <br />PERMIT <br />REQUIREMENT <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />* * * * ** <br />Twice Per <br />Month <br />VISUAL <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER <br />I cendy under penalty of law that Bus document and all attachments were prepared under t dlrechon or <br />mpervenona accordance ttnhasynemdestgnedm assure that qunidiedpervonnelproperrly gather and <br />1 I the f t l tt d B d y guy f Ih pe pe h e• ih <br />+t stem, of tat person d a n d re llef,tue, forgmhcnn the I n thee thatthere are g vnbmn4J <br />to the e” of tat knowledge and mate true, accurate and ssatIt to I nm aware pro there t coot <br />perolhev for +ubrmtlmg lake mformohnn tncludmg the pasvtbddy of fine and tmpmm�ment far lnowmg <br />y, l t <br />/ <br />TELEPHONE <br />DATE <br />TA 77���� V <br />I D I "T <br />Q.I/alS� - L {'fl �C 1�1 r1 ^ t ' C () <br />ppp <br />/ O3 ) <br />I <br />y6 <br />7 <br />` , -/ ] <br />�•(J(� <br />C/ / "I <br />°71 (2-0(2..'- <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />AREA Code I <br />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.01106) 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 />08/01/2012 <br />MM /DD/YYYY <br />08/31/2012 <br />TO <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 Discharg <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 />07/30/2012 Page 2 <br />