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PERMITTEE NAME /ADDRESS: <br />NAME: MOUNTAIN COAL COMPANY, LLC <br />ADDRESS: WEST ELK MINE <br />P.O. BOX 591 <br />SOMERSET CO 81434 <br />FACILITY: WEST ELK MINE <br />LOCATION: APPX 1 MI E OF TOWN ON HWY 133 <br />SOMERSET, CO 81434 <br />PARAMETER <br />La <br />00400 1 0 <br />EFFLUENT GROSS <br />SOLIDS, TOTAL <br />SUSPENDED <br />00530 1 0 <br />EFFLUENT GROSS <br />SOLIDS, SETTLEABLE <br />00545 1 0 <br />EFFLUENT GROSS <br />IRON, TOTAL <br />(AS FE) <br />01045 1 0 <br />EFFLUENT GROSS <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />C00038776 018A -USED. POND TO SYLVESTER GULCH <br />PERMIT NUMBER DISCHARGE NUMBER (SUER MH) GUNIS <br />EXTERNAL OUTFALL <br />MONITORING PERIOD MINOR <br />FROM To NO DISCHARGE <br />f'1 Ct51UtN I NOTE: Read instructions before com pieting this form. <br />QUALITY OR LOADING <br />QUALITY OR CONCENTRATION <br />MEASUREMENT <br />03582 1 0 <br />PERMIT <br />EFFLUENT GROSS <br />MONTH <br />REQUIREMENT <br />NO. <br />FREQUENCY <br />SAMPLE <br />VALUE VALUE UNITS VALUE VALUE VALUE <br />UNIT <br />MEASUREMENT <br />EX <br />TYPE <br />EFFLUENT GROSS <br />REQUIREMENT <br />SOLIDS, TOTAL <br />gNAOLF <br />SAMPLE <br />SAMPLE <br />MEASUREMENT <br />70295 1 0 <br />MEASUREMENT <br />EFFLUENT GROSS <br />(12) <br />REQUIREMENT':. <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER <br />PERfAT <br />ONCI✓ t <br />REQtIREMENT : <br />SU <br />MONTH <br />INSITU :: <br />SAMPLE <br />MEASUREMENT <br />(19) <br />P RM+T <br />ONCE t <br />REQUIREMENT <br />mg /L <br />MONTH : <br />GRAB' <br />SAMPLE <br />MEASUREMENT <br />(25) <br />PR1ut1T <br />ONCE t <br />REQUIREMENT : <br />mL /L /h <br />MONTH.:: <br />GRAB, <br />MEASUREMENT <br />NO D <br />�RMIT <br />REQUIREMENT <br />I CERTFY UNDER PENALTY OF LAW THAT THIS DOCUMENT AND ALL ATTACHMENTS WERE PREPARED UNDER MY <br />DIRECTION OR SUPERVISION IN ACCORDANCE WITH A SYSTEM DESIGNED TO ASSURE THAT QUALIFIED PERSONNEL <br />PROPERLY GATHER AND EVALUATE THE INFORMATION SUBMITTED. BASED ON MY INQUIRY OF THE PERSON OR <br />PERSONS WHO WHO MANAGE THE SYSTEM, OR THOSE PERSONS DIRECTLY RESPONSIBLE FOR GATHERING THE y <br />AND <br />INFORMATION. MOAWARETHAT THERE DARETSIGN SIGNIFICANT PENALTIES YFOR SUBMRTNG ALSEUNFORMATTK>N SIGNATURE OF PRINCIPAL EXECUTIVE <br />Weston Norris INCLUDING THE POSSIBILITY OF FINE AND IMPRISONMENT FOR KNOWING VIOLATIONS <br />TYPED OR PRINTED OFFICER OR AUTHORIZED AGENT <br />f- nRA\ACAIT AAIr1 CV0I AAIATInKI nC AAIV \ /Inl ATInKIC io,. � .............N .. u.... r......... �., ti -,.I <br />(28) <br />SAMPLE <br />OIL AND GREASE <br />MEASUREMENT <br />03582 1 0 <br />PERMIT <br />EFFLUENT GROSS <br />MONTH <br />REQUIREMENT <br />FLOW, IN CONDUIT OR <br />SAMPLE <br />THRU TREATMENT PLANT <br />MEASUREMENT <br />50050 1 0 <br />PERMIT <br />EFFLUENT GROSS <br />REQUIREMENT <br />SOLIDS, TOTAL <br />SAMPLE <br />DISSOLVED <br />MEASUREMENT <br />70295 1 0 <br />PERT::.. <br />EFFLUENT GROSS <br />REQUIREMENT':. <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER <br />I CERTFY UNDER PENALTY OF LAW THAT THIS DOCUMENT AND ALL ATTACHMENTS WERE PREPARED UNDER MY <br />DIRECTION OR SUPERVISION IN ACCORDANCE WITH A SYSTEM DESIGNED TO ASSURE THAT QUALIFIED PERSONNEL <br />PROPERLY GATHER AND EVALUATE THE INFORMATION SUBMITTED. BASED ON MY INQUIRY OF THE PERSON OR <br />PERSONS WHO WHO MANAGE THE SYSTEM, OR THOSE PERSONS DIRECTLY RESPONSIBLE FOR GATHERING THE y <br />AND <br />INFORMATION. MOAWARETHAT THERE DARETSIGN SIGNIFICANT PENALTIES YFOR SUBMRTNG ALSEUNFORMATTK>N SIGNATURE OF PRINCIPAL EXECUTIVE <br />Weston Norris INCLUDING THE POSSIBILITY OF FINE AND IMPRISONMENT FOR KNOWING VIOLATIONS <br />TYPED OR PRINTED OFFICER OR AUTHORIZED AGENT <br />f- nRA\ACAIT AAIr1 CV0I AAIATInKI nC AAIV \ /Inl ATInKIC io,. � .............N .. u.... r......... �., ti -,.I <br />(28) <br />ONCE 1: <br />N9 /L <br />MONTH <br />GRAB <br />(19) <br />CONTIN <br />mg /L <br />GENT:GRA$I <br />ONCEt <br />.,. INSTANT: <br />MONTH <br />QTRLY GRAB <br />TELEPHONE I DATE <br />970 - 929 -5015 <br />Forms by <br />7/15/2014 <br />MM/DD /YYYY <br />TSS & TOTAL IRON LIMITS WILL BE WAIVED, AND SETTLEABLE SOLIDS LIMIT APPLIED FOR < 10YR, 24HR PRECIP EVENT -SEE I.A.2, PG 5, FOR REQUIREMENTS. 30 DAY AVG IS HIGHEST <br />MONTHLY AVERAGE DURING REPORTING PERIOD. QUARTERLY SAMPLING & REPORTING INSTRUCTIONS- I.C.11. OIL & GREASE -SEE LBA.F. <br />00201/980409 PAGE 1 OF 2 <br />