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PARAMETER <br />I emnfy und. penny of law that this document and all attachments scare piepared under m) direction or <br />supervision inm,eordame with a water, designed to assure that qualified persmmel mpedv gather and <br />valuate the information submitted Based on my nrgmr, of the person or persons who manage the <br />system or those pei sons directly t able for gathering the nrfunnamm the information submitted is, <br />to me best of ion ktmwled and beolilieef, f. tare, accurate and complete I am aware that mere are significant <br />ltofin subnnumgfal s soentforknowing <br />information, meludingthe posarbdrq of fine and no1n m, <br />pnns <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FREQUENCY <br />OF ANALYSIS <br />ST PEE <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 />0 <br />*,•,,• <br />• *• „* <br />0 <br />0 <br />l /3o <br />f q <br />U; S <br />PERMIT <br />REQUIREMENT <br />*'• * ** <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />* *•••• <br />* * * * ** <br />* * * * ** <br />Monthly <br />VISUAL <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICE <br />I emnfy und. penny of law that this document and all attachments scare piepared under m) direction or <br />supervision inm,eordame with a water, designed to assure that qualified persmmel mpedv gather and <br />valuate the information submitted Based on my nrgmr, of the person or persons who manage the <br />system or those pei sons directly t able for gathering the nrfunnamm the information submitted is, <br />to me best of ion ktmwled and beolilieef, f. tare, accurate and complete I am aware that mere are significant <br />ltofin subnnumgfal s soentforknowing <br />information, meludingthe posarbdrq of fine and no1n m, <br />pnns <br />- <br />TELEPHONE <br />DATE <br />1 - /- <br />u { I <br />SIGNATURE F PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />AREA Code <br />I NUMBER <br />MM /DD/YYYY <br />TYPED OR PRINTED <br />PERMITTEE NAME /ADDRESS (Include Facility Name/Location if Different) <br />NAME: Peabody Sage Creek Mining LLC <br />ADDRESS: 29515 Routt CR 27 <br />Oak Creek, CO 80467 <br />FACILITY: <br />LOCATION: <br />ATTN. Mike Ludlow, GM <br />SAGE CREEK MINE COMPLEX <br />36600 CR 27 <br />HAYDEN, CO 81639 <br />Dennis Jones <br />Hydrologist 1 <br />(970) 276 -5209 <br />C00048275 <br />PERMIT NUMBER <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 />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />Settleable solids limits waived for >10YR,24HR precip event subject to burden of proof in I.A.2 Quarterly monitoring - see C.10, pg 10. <br />004 -A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD /YYYY <br />07/01/2012 <br />MM /DD /YYYY <br />09/30/2012 <br />TO <br />DMR Mailing ZIP CODE: 80467 <br />MAJOR <br />ROUTT <br />Discharge to Fish Creek <br />External Outfall <br />Form Approved - <br />OMB No 2040 -0004 <br />No Discharger <br />12/09/2011 Page 2 <br />