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PERMITTEE NAME /ADDRESS (Include Facility Name/Location If Different)
<br />NAME:
<br />Hayden Gulch Terminal Inc
<br />ADDRESS:
<br />PO Box 670
<br />NO
<br />EX
<br />Hayden, CO 81639 -0670
<br />FACILITY:
<br />HAYDEN GULCH LOADOUT
<br />LOCATION:
<br />2 MI S OF TOWN, OFF RCR 53
<br />VALUE
<br />HAYDEN, CO 81639
<br />ATTN: Roy Karo, Rec Mgr
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />COG850008 001 -A
<br />PERMIT NUMBER I DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />MM /DD /YYYY MM /DD/YYYY
<br />FROM 04/01/2013 TO 06/30/2013
<br />Form Approved
<br />OMB No 2040 -0004
<br />DMR Mailing ZIP CODE: 8136 -0670
<br />MINOR
<br />(SUBR JC) ROUTT
<br />POND (SW /4) TO DRY CRK/YAMPA
<br />External Outfall
<br />No Discharge
<br />PARAMETER
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<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 />—I
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<br />a
<br />SIG URE OF PRINCIPAL EXECUTIVE OFFICER OR
<br />AUTHORIZED AGENT
<br />AREA Code
<br />NUMBER
<br />MMIDD /YYYY
<br />Oil and grease visual
<br />SAMPLE
<br />* * *. **
<br />, *. * **
<br />MEASUREMENT
<br />840661 0
<br />Effluent Gross
<br />PERMIT
<br />I REQUIREMENT
<br />* * * * **
<br />Req. Mon.
<br />INST MAX
<br />Y =1,N =0
<br />...
<br />* * * * **
<br />* * * **
<br />Twice Per
<br />Month
<br />VISUAL
<br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER
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<br />TELEPHONE
<br />DATE
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<br />a
<br />SIG URE OF PRINCIPAL EXECUTIVE OFFICER OR
<br />AUTHORIZED AGENT
<br />AREA Code
<br />NUMBER
<br />MMIDD /YYYY
<br />TYPED OR PRINTED
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) v
<br />SETTLEABLE SOLIDS LIMITS WAIVED FOR 10 -YR, 24 HR PRECIP EVENT SUBJECTTO BURDEN OF PROOF REQUIREMENTS INPART I.B 6. ANY ADDITIONAL DATA SHALL BE SUPPLIED TO THE DIVISION WITHIN 48 HOURS
<br />EPA Form 3320 -1 (Rev.01106) Previous editions may be used. 01/04/2013 Page 2
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