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PERMITTEE NAME /ADDRESS (Include Facility Name /Location it Different) <br />NAME: Moffat County Mining LLC <br />ADDRESS: 29515 Routt CR 27 <br />Oak Creek, CO 80467 -9704 <br />FACILITY- WILLIAMS FORK MINE <br />LOCATION: 1030 CR 107 <br />CRAIG, CO 81626 <br />ATTN- Jerry Nettleton, Sup <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />000034142 022 -A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />MM /DD/YYYY MM /DD /YYYY <br />4/1/2013 6/30/2013 <br />Form Approved <br />OMB No 2040 -0004 <br />DMR Mailing ZIP CODE: 80467 -9704 <br />MINOR <br />Spoils Springs to Channel Prior to Discharge to Willis <br />External Outfall <br />No Discharge EJ <br />NAMEfTITLE PRINCIPAL EXECUTIVE OFFICER <br />I ,mly un, r penalty of raw that this document and 11 attachments were prepared under my direction or <br />sup- -r m accordance with a system designed to assure that qualified personnel properly gather and <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FREQUENCY <br />SAMPLE <br />PARAMETER <br />q / _� <br />p�jA G ( <br />!�}fJ li O <br />EX <br />OF ANALYSIS <br />TYPE <br />VALUE <br />VALUE <br />UNITS <br />VALUE <br />VALUE <br />VALUE <br />UNITS <br />Oil and grease visual <br />SAMPLE <br />MEASUREMENT <br />* * * * ** <br />!; <br />* " * * ** <br />" "``* <br />`` " " "" <br />" *` *`* <br />840661 0 <br />PERMIT <br />* * " * "" <br />Req. Mon. <br />Y =1,N =0 <br />"* <br />* * * * ** <br />" "" <br />Twice Per <br />VISUAL <br />Effluent Gross <br />REQUIREMENT <br />INST MAX <br />Month <br />NAMEfTITLE PRINCIPAL EXECUTIVE OFFICER <br />I ,mly un, r penalty of raw that this document and 11 attachments were prepared under my direction or <br />sup- -r m accordance with a system designed to assure that qualified personnel properly gather and <br />/ <br />TELEPHONE <br />DATE <br />117T- ,/J <br />f) f / <br />valuale the mformat— submitted Based on my inquiry of the person or persons who manage the <br />system or those persons d,rectiy responsible" gathering the m /ormation, the m(armation submilled,s <br />to the best of my knowledge and belief true accurate and complete I am aware that there are <br />e�gmficant ponalt— for sebmmmg falsemformalmn mcludmg the possibidy of fine andrmpr em for <br />y' •q / / /.- �,. `' <br />�./ Y L/ _ <br />q / _� <br />p�jA G ( <br />!�}fJ li O <br />[0[ � 7 <br />�i <br />/ <br />SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER OR <br />TYPED OR PRINTED <br />owing wdabons <br />AUTHORIZED AGENT <br />AREA Code <br />NUMBER <br />I MMIDDlVYYv <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />Oil and grease sample required if visible sheen is observed. Qtrly sampling instructions - I C 12, pg 11 <br />EPA Form 3320 -1 (Rev.01 /06) Previous editions may be used. 05/08/2013 Page 4 <br />