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PARAMETER <br />I ""'ry "nd°p°" °y°rbwwlm,'d''amt,'' amen ''hmntmwem <br />supwtswn m accordance with a system designed to assure that yuahficd personne prop wither and <br />evaluate the information submitted Based on my inquiry of the person or pawns who manage the <br />system. ur Neu ma sons Mostly responsible for gatheng the inf om,thc information submittd , <br />to the best of my knowledge ad belief, true, accurate, and complete I am aware that there art sib tfiu'v <br />penalties for submitting false inf tae, including the possibility of fine and nmpnsomant f knowing <br />taattoms <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 />8406610 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />...... <br />M <br />t DM'Y <br />TYPED OR PRINTED <br />TYPED <br />, <br />PERMIT <br />REQUIREMENT <br />""" <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />"•"' <br />""" <br />""" <br />Twice Per <br />Month <br />VISUAL <br />Nf ME /TITLEPRINCIPALEXECUTIVEOFFICER <br />1 <br />I ""'ry "nd°p°" °y°rbwwlm,'d''amt,'' amen ''hmntmwem <br />supwtswn m accordance with a system designed to assure that yuahficd personne prop wither and <br />evaluate the information submitted Based on my inquiry of the person or pawns who manage the <br />system. ur Neu ma sons Mostly responsible for gatheng the inf om,thc information submittd , <br />to the best of my knowledge ad belief, true, accurate, and complete I am aware that there art sib tfiu'v <br />penalties for submitting false inf tae, including the possibility of fine and nmpnsomant f knowing <br />taattoms <br />, / <br />( <br />. —. �' -'( t '`�, i • - <br />t �/ <br />TELEPHONE <br />DATE <br />_ , q <br />7 X _.r i? _ C t om " <br />G' / / �.T U <br />/n/ <br />V <br />Is <br />{ Zg/ 3 <br />/ <br />:J y ." -- . <br />Z('l . ` <br />k . l C C,I <br />p e- Y } <br />t <br />h� <br />/S IGNATURE OF Pl4NCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />Code NUMBER <br />M <br />t DM'Y <br />TYPED OR PRINTED <br />TYPED <br />, <br />PERMITTEE NAME/ADDRESS (Include FacdityName/Local/on ifDiferent) <br />NAME: Terror Creek LLC <br />ADDRESS: 43440 Bowie Rd <br />Paonia, CO 81428 <br />FACILITY: TERROR CREEK LOADOUT <br />LOCATION: 43440 BOWIE ROAD <br />PAONIA, CO 81428 <br />ATTN: JAMES T. COOPER, PRESIDENT <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 />COG850028 <br />PERMIT NUMBER <br />001 A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />10/01/2012 <br />MM /DD/YYYY <br />12/31/2012 <br />TO <br />DMR Mailing ZIP CODE: 81428 <br />MINOR <br />DELTA <br />SEDI POND #1 TO N FORK GUNNISN <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 />SETTLEABLE SOLIDS LIMIT WAIVED FOR10 -YR, 24 HR PRECIPT EVENT SUBJECTTO BURDEN OF PROOF REQUIREMENTS INPART I.B.6. ANY ADDITIONAL DATA SHALL BE SUPPLIED TO THE DIVISION WITHIN 48 HOURS <br />Page 2 <br />