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PARAMETER <br />1 certify under penalty of 4w that this document and all attachments were prepared under my dmrenhon or <br />supervision m accordance with a system &awned to assure that 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 />PERMIT <br />REQUIREMENT <br />•••••• <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />•`"••' <br />•••••• <br />Weekly <br />VISUAL <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER <br />1 certify under penalty of 4w that this document and all attachments were prepared under my dmrenhon or <br />supervision m accordance with a system &awned to assure that qualified personnel properly gather and <br />/ �T" <br />TELEPHONE <br />DATE <br />Trni eV <br />lust the f mmah sub tted. Based on my Inquiry of the person or persons who manage the <br />to the system, or those persons d and belief, responsible for enn the mf ete. I a n, the aware that t re e arc sim fi as, <br />P nelhes for sumitbmrg false knowledge e and u accurate, the d e possibil ty of fie and imprisonment for k <br />violations. <br />�� 9�9 - 521s <br />///a) l aw r <br />1 <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />AREA Code <br />( NUMBER <br />r <br />MM/DD/YYW <br />TYPED OR PRINTED <br />PERMITTEE NAME/ADDRESS (include Fac ,ihv Name/Location ifDifferent) <br />NAME: Bowie Resources LLC <br />ADDRESS: PO Box 483 <br />Paonia, CO 81428 <br />FACILITY: BOWIE NO. 2 MINE <br />LOCATION: 5 MI NE OF TOWN ON CO HWY 133 <br />PAONIA, CO 81428 <br />ATTN: BRADLEY E. HANSON, VICE PRES. <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 />C00044776 <br />PERMIT NUMBER <br />009A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />89i0 <br />MM /DD/YYYY <br />/6 /o � ?D _ <br />TO <br />d �3 <br />Form Approved <br />OMB No. 2040-0004 <br />DMR Mailing ZIP CODE: 81428 <br />MINOR <br />(SUBR MH) DELTA <br />SR DSCH /UNNMD TRIB /HUBBARD CRK <br />External Outfall <br />No Discharge <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />SETTLEABLE SOLIDS LIMIT APPLIES ONLY IF <10YR/24HR PRECIP EVENT IS CLAIMED. IF CLAIM APPROVED BY WQCD,TSS & IRON LIMITS WILL NOT BE APPLIED TO RPTD MEASUREMENTS -SEE IA3,PG. 4-5 FOR BURDEN OF <br />PROOFREQUIREMENTS. OIL & GREASE - I.B.1.3, PG. 9. QRTRLY SAMPLING INSTRUCTIONS - I.C.10, PG. 10. <br />Page 2 <br />