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PARAMETER <br />I certIfy under penalty of law that tins document and all attachments were prepared under my &motion or <br />s in accordance with a system designed to assure that qualified personnel properly gather and <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 />* * * * ** <br />* *. * ** <br />* * * * ** <br />* * *. ** <br />PERMIT <br />REQUIREMENT <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />* * * * ** <br />* * * * ** <br />Weekly <br />VISUAL <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER <br />I certIfy under penalty of law that tins document and all attachments were prepared under my &motion or <br />s in accordance with a system designed to assure that qualified personnel properly gather and <br />TELEPHONE <br />DATE <br />l� w P. <br />n ,�a <br />`�" r r n e <br />v 1 te <br />v 1 to the f non submitted Based on my inquiry of the person or persons who manage the <br />system, or those persons directly responsible for gathering the complete I non, the information submitted is, <br />o he best of my knowledge and belief, true, accurate, and complete 1 am aware that there are significant <br />penalties for submittmg false mformanon, mcludmg the posstbdity of fine and impnsonment for knowing <br />violations <br />^ <br />`/ <br />•��� <br />� <br />/� / <br />( {/ <br />� <br />S IGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />AREA Code <br />NUMBER <br />MM/DDIYYYY <br />PED OR PRINTED <br />PERMITTEE NAME /ADDRESS (Include FacilityName/Location /f Different) <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 />IVt1I IIJIN AL I I /11M1 UlJlirlHKl7t tLIIVIIIVH I ILAN J YJ 1 tM (NF'UtJ) <br />DISCHARGE MONITORING REPORT (DMR) <br />C00044776 <br />PERMIT NUMBER <br />009A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />MM /DD /YYYY <br />egmaiasea— <br />FROM <br />1?-10/ (c) <br />TO <br />Lai 3i Idu2_ <br />l-orm 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 IA.3,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 />EPA Form 3320 -1 (Rev.01 /06) Previous editions may be used. <br />Page 2 <br />