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PARAMETER <br />I cal under penalty of Inn that thta document and all nttnchmentr were prepared under m hrecton or <br />"'Tem.. an m accordance w oh a whom aengnea to rweure that mmheea peraonnel propeav gather and <br />at t the information n,hmmed Bared on my inquire of the porton or pereone who manage the <br />tot em r dim pr a directly re lie yule far accurate enng the m Ido I am the mrnmth nibmnt i n <br />l e l na m! m n ncung te po Ibmoi e a d Imp„ g o g <br />I t <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FREQUENCY <br />ANALYSIS <br />SAM E <br />OF <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 />0 <br />t f q <br />V <br />PERMIT <br />REQUIREMENT <br />Req Mon. <br />INST MAX <br />Y =1:N =0 <br />"` "" <br />"""" <br />Twice Per <br />Month <br />VISUAL <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER <br />I cal under penalty of Inn that thta document and all nttnchmentr were prepared under m hrecton or <br />"'Tem.. an m accordance w oh a whom aengnea to rweure that mmheea peraonnel propeav gather and <br />at t the information n,hmmed Bared on my inquire of the porton or pereone who manage the <br />tot em r dim pr a directly re lie yule far accurate enng the m Ido I am the mrnmth nibmnt i n <br />l e l na m! m n ncung te po Ibmoi e a d Imp„ g o g <br />I t <br />''- <br />TELEPHONE <br />DATE <br />f t) PA+CTQf p6E Pa'D6 4- <br />_ / _ <br />• j Vi-- d - <br />- 303, 930 — 4b (0s <br />O ( j24 /200 <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />AUTHORIZED AGENT <br />AREA code I NUMBER <br />MM /DD/Y`rYY <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: <br />LOCATION: <br />EDNA MINE <br />26990 COLORADO HWY 131 <br />OAK CREEK, CO 80467 <br />ATTN: Jim Tarazoff, Land Mgr <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 />C00032638 <br />PERMIT NUMBER <br />007 -A <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY <br />12/01/2012 <br />MM /DD/YYYY <br />12/31/2012 <br />TO <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.3, PG. 4, FOR REQUIREMENTS.QRTRLY SAMPLING INSTRUCTIONS - I.C.10, PG. 9. <br />DMR Mailing ZIP CODE: 80112 <br />MINOR <br />Form Approved <br />OMB No 2040 -0004 <br />ROUTT <br />DSCHG TO KOLL DITCH #3 /TROUT CR <br />External Outfall <br />No Discharger <br />07/30/2012 Page 2 <br />