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PERMITTEE NAME /ADDRESS (Include FacilityName/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 002 -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 (SE /4) TO DRY CRK /YAMPA
<br />External Out fall �{
<br />No Discharge r
<br />PARAMETER
<br />dt nna "�° °, .'l l•'n In "III °'e „<nlnenl and 11 ti -N `nt ".`„ hl,p— dvnd,, ,, a " "e " ° "`
<br />aulxr ,nlnn w11h n sv,lem Je +IpneJ In ns,ure Ihal qu,IlI nI I. ....... d pnq,elh gather
<br />, nlunte dte rnfomuman auhlnitic,l Ha,ttl on nry mywn of Ilrc IxrNnl or Ixr9on +,. ho nu�nage Ih.
<br />vc stem or those [,e...... lreclh c,lx,nvlhlc for gmhenng the mlomtanon the Inlonnnhon ,uhmnle� I,
<br />In the heal nl nn IJtut Wge tn.l Ix•hel ll ue eccurate and curttl,lelc 1 um an,ne Ihnt Ihele ale vlgmhe"nt
<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 />TYPED OR PRINTED
<br />Oiland grease visual
<br />SAMPLE
<br />......
<br />......
<br />......
<br />......
<br />......
<br />MEASUREMENT
<br />840661 0
<br />PERMIT
<br />' ...
<br />Req. Mon.
<br />Y =1,N =0
<br />" " "'
<br />"' " "`
<br />.. ""
<br />.....
<br />Twice Per
<br />Effluent Gross
<br />REQUIREMENT
<br />INST MAX
<br />Month
<br />VISUAL
<br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER
<br />dt nna "�° °, .'l l•'n In "III °'e „<nlnenl and 11 ti -N `nt ".`„ hl,p— dvnd,, ,, a " "e " ° "`
<br />aulxr ,nlnn w11h n sv,lem Je +IpneJ In ns,ure Ihal qu,IlI nI I. ....... d pnq,elh gather
<br />, nlunte dte rnfomuman auhlnitic,l Ha,ttl on nry mywn of Ilrc IxrNnl or Ixr9on +,. ho nu�nage Ih.
<br />vc stem or those [,e...... lreclh c,lx,nvlhlc for gmhenng the mlomtanon the Inlonnnhon ,uhmnle� I,
<br />In the heal nl nn IJtut Wge tn.l Ix•hel ll ue eccurate and curttl,lelc 1 um an,ne Ihnt Ihele ale vlgmhe"nt
<br />r /1
<br />_ `� I
<br />TELEPHONE
<br />DATE
<br />N H (.)
<br />i+
<br />l- I
<br />e- C�
<br />rt''tl'l`en`lor euhmnbrtg hdse uduunnhon ualu.hng tlx lwsvbthq ul hnuuul uulx wmmmmfor Mow u'g
<br />SIG TURE OF PRINCIPAL EXECUTIVE OFFICER OR
<br />AUTHORIZED AGENT
<br />AREA Code
<br />NUMBER
<br />MMIDDIYYYY
<br />TYPED OR PRINTED
<br />COMMENTS AND EXPLANATION OF AP7 VIOLATIONS (Reference all attachments here) 11
<br />SETTLEABLE SOLIDS LIMITS WAIVED FOR 10 -YR, 24 HR PRECIP EVENT SUBJECTTO BURDEN OF PROOF REQUIREMENTS IN PART 1.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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