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PARAMETER <br />I certify under penalty of law that this document and all attachments were prepared under m, drrectmnor <br />omen wry in accordance ugh n ayetcm m <br />deatgned to nese that d personnel properly gather and <br />1 t the mfoememantio tinn submitted Based on my inquiry of the person or persons oho manage the <br />system or <br />to the hel of sot mei Ipe and belief trnec for gathering information <br />I aware hot there nrc t <br />penalties for submitting false information including the possibility of fine and imprisonment for knowing <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 />Solids, total dissolved <br />70295 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />NUMBER <br />MM /DD/YYYY <br />* *��xx <br />TYPED OR PRINTED <br />-- <br />NO <br />D. tscs KA <br />-GE <br />������ <br />PERMIT <br />REQUIREMENT <br />" "" <br />" " "' <br />Req. Mon. <br />QRTR AVG <br />Req. Mon. <br />QRTR MAX <br />mg /L <br />Quarterly <br />GRAB <br />Oil and grease visual <br />84066 1 0 <br />Effluent Gross <br />SAMPLE <br />MEASUREMENT <br />i <br />_ <br />N C <br />L' 1SC4-tA <br />Q <br />PERMIT <br />REQUIREMENT <br />Req. Mon. <br />INST MAX <br />Y =1;N =0 <br />Twice Mon her <br />VISUAL <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER <br />I certify under penalty of law that this document and all attachments were prepared under m, drrectmnor <br />omen wry in accordance ugh n ayetcm m <br />deatgned to nese that d personnel properly gather and <br />1 t the mfoememantio tinn submitted Based on my inquiry of the person or persons oho manage the <br />system or <br />to the hel of sot mei Ipe and belief trnec for gathering information <br />I aware hot there nrc t <br />penalties for submitting false information including the possibility of fine and imprisonment for knowing <br />TELEPHONE <br />0 <br />DATE <br />,`u" Q/� <br />�^ `� /n (•"7 �AWr- <br />'` P RO's rpm <br />_i 7 <br />�� ' <br />(3Q 3 <br />l <br />30 —1-005 <br />G 1l4/20 / <br />3 <br />SIGNATURE OF AUTHORIZED PRINCIPAL AGENT EXECUTIVE OFFICER OR <br />AREA Code <br />NUMBER <br />MM /DD/YYYY <br />TYPED OR PRINTED <br />PERMITTEE NAME /ADDRESS (Include Facility Name/Locahon if Different) <br />NAME: Chevron Mining Inc <br />ADDRESS: 116 Inverness Dr E Ste 207 <br />Englewood, CO 80112 <br />FACILITY: EDNA MINE <br />LOCATION: 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 />004 -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.2, 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 />SURFACE RUNOFF TO TROUT CREEK <br />External Outfall <br />No Discharge <br />07/30/2012 Page 2 <br />