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PERMITTEENAME /ADDRESS (Include Facility Name/Location ifDifferent)
<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 I I 002 -A
<br />PERMIT NUMBER I I DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />MM /DD /YYYY I MM /DD /YYYY
<br />FROM 04/01/2013 j TO 1 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 Outfall •��
<br />No Discharge��l A
<br />PARAMETER
<br />nnJer�e " " °a.-- lhmlhnJod— nidw .11•WrathunullswmePupaa•JunJcu "' a h�-"d„
<br />salxr mi,n with n sesem Jc.igncJ to ns +ure t1in1 yualirteJ rcix nel Pn�lxtl, gnlhci nuJ
<br />,'I"'te�the�u,lon,,,hon vuMnnteJ 13 „eJ on m, �nquin of ihi Ixrs<�n or Ixrso�n,
<br />system or those Persons Jrtecth e.rym,ihic lot getixnng the inlonnation �hc uilo�nun�on .nhnuileJ i.'
<br />to dx hest o1 nn 1- Wge and Inher hue e«urate - d..omplo, I mn nwnu• thin thcie me agudavmt
<br />Chu ` „i °raa,,,ttttngrta,et„wn,,,t „tohJngmeP""'Idn3"t11 --du'p ,tnenu,rti „wng
<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 />Oiland grease visual
<br />SAMPLE
<br />......
<br />,,,,,,
<br />,,,,
<br />„ ",,,
<br />,,,,„
<br />MEASUREMENT
<br />840661 0
<br />Effluent Gross
<br />PERMIT
<br />I REQUIREMENT
<br />" " " "'
<br />I
<br />Req. Mon.
<br />I INST MAX
<br />Y =1,N =0
<br />''' ""
<br />" ""
<br />" ""
<br />"' " ""
<br />Twice Per
<br />Month
<br />VISUAL
<br />i
<br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER
<br />nnJer�e " " °a.-- lhmlhnJod— nidw .11•WrathunullswmePupaa•JunJcu "' a h�-"d„
<br />salxr mi,n with n sesem Jc.igncJ to ns +ure t1in1 yualirteJ rcix nel Pn�lxtl, gnlhci nuJ
<br />,'I"'te�the�u,lon,,,hon vuMnnteJ 13 „eJ on m, �nquin of ihi Ixrs<�n or Ixrso�n,
<br />system or those Persons Jrtecth e.rym,ihic lot getixnng the inlonnation �hc uilo�nun�on .nhnuileJ i.'
<br />to dx hest o1 nn 1- Wge and Inher hue e«urate - d..omplo, I mn nwnu• thin thcie me agudavmt
<br />Chu ` „i °raa,,,ttttngrta,et„wn,,,t „tohJngmeP""'Idn3"t11 --du'p ,tnenu,rti „wng
<br />/�
<br />V 1
<br />TELEPHONE
<br />DATE
<br />N ro -
<br />' h CZ
<br />, l
<br />©�.t .��1 poi 3
<br />SIG TUREOFPRINCIPALEXECUTIVEOFFICEROR
<br />AUTHORIZED AGENT
<br />AREA Code
<br />NUMBER
<br />MMIDD/YYYY
<br />TYPED OR PRINTED
<br />COMMENTS AND EXPLANATION OF AIV VIOLATIONS (Reterence all attachments here) i
<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.01 /06) Previous editions may be used. 01/04/2013 Page 2
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