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PERMITTEE NAME /ADDRESS: <br />NAME: <br />MOUNTAIN COAL COMPANY, LLC <br />ADDRESS: <br />WEST ELK MINE <br />P.O. BOX 591 <br />SOMERSET CO 81434 <br />FACILITY: <br />WEST ELK MINE <br />LOCATION: <br />APPX 1 MI E OF TOWN ON HWY 133 <br />EX <br />SOMERSET, CO 81434 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />C00038776 Oil CUTE WET TESTING FOR 011A <br />PERMIT NUMBER DISCHARGE NUMBER (SUBR MH) MNTRS <br />EXTERNAL OUTFALL <br />MONITORING PERIOD MINOR <br />FROM To NO DISCHARGE <br />A I I N: Ktl I H K. VVILLIAIVIS, HKt51UtN I NOTE: Read instructions before c mpleting this form. <br />SAMPLE <br />QUALITY OR LOADING QUALITY OR CONCENTRATION <br />PARAMETER <br />NO. <br />FREQUENCY <br />SAMPLE <br />VALUE VALUE UNITS VALUE VALUE VALUE UNIT <br />EX <br />OF <br />TYPE <br />SAMPLE <br />ANALYSIS <br />LC50 STATRE 48HR ACU <br />DAPHNIA MAGNA <br />MEASUREMENT ! (23) <br />PERMIT :'. <br />TAM3C 1 0 <br />................ <br />PFRIa1EIT:;:;:;:;:', <br />...... <br />.. ....... <br />EFFLUENT GROSS SEE COMMENTS <br />ft QiJIR t�I NT; <br />:::.:.:.:.:.:.:::.:.:.:::.:::: NO D PERCENT.... <br />SAMPLE <br />:::::::::::: <br />QTRLY <br />::::::::::::::::::::::::::::::: <br />M. 13 <br />LC50 STATRE 96HR ACU <br />PIMEPHALES <br />MEASUREMENT <br />TANK 1 0 <br />F?ERNFIT; <br />EFFLUENT GROSS <br />REQiJIREMENT' PERCENT;.: <br />Q_ T�R: L.Y..:: <br />:::GRAB ' <br />MEASUREMENT <br />SEE I.A.5, PP. 6 -7, FOR DETAILS OF TEST PROCEDURE. REPORT LC50 - STATISTICAL POINT ESTIMATE WHICH IS LETHAL TO 50% OF THE TEST ORGANISMS, AND ATTACH ACUTE TOXICITY <br />TEST REPORT FORM TO DMR. <br />00105/980409 -1716 PAGE 1 OF 1 <br />SAMPLE <br />MEASUREMENT <br />PERMIT :'. <br />REC3Ull?EMEIT <br />SAMPLE <br />MEASUREMENT <br />pEFMiT <br />... <br />...... ... . <br />.. <br />REQUIREMENT.:: <br />.:. <br />.:::::::. <br />SAMPLE <br />MEASUREMENT <br />:::::::' <br />. <br />— — <br />.::::: .. <br />_ _:, . ...... ........................ <br />:::::::. <br />............... <br />.......... .. ............ <br />..... <br />;.. . <br />NAME / TITLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />DATE <br />1 CERTIFY 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 MANAGE THE SYSTEM, OR THOSE PERSONS DIRECTLY RESPONSIBLE FOR GATHERING THE <br />Weston THE INFORMATION SUBMITTED IS, TO THE BEST OF MY KNOWLEDGE AND BELIEF, TRUE, ACCURATE: Norris AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, <br />SIGNATURE OF PRINCIPAL EXECUTIVE 970 - 929 -5015 <br />4/21/2015 <br />INCLUDING THE POSSIBI LILY OF FINE AND IMPRISONMENT FOR KNOWING VIOLATIONS. <br />MM /DD/YYYY <br />TYPED OR PRINTED <br />OFFICER OR AUTHORIZED AGENT <br />C'.CIAAMFNT ANr) FXPI ANATIr)N C)P ANY \ /101 ATICINC �u �H­Am fn 1 e 1 <br />Forms by WindowChem( <br />707 )864- 0845;p/n11090;v5.0;1/1/96 <br />SEE I.A.5, PP. 6 -7, FOR DETAILS OF TEST PROCEDURE. REPORT LC50 - STATISTICAL POINT ESTIMATE WHICH IS LETHAL TO 50% OF THE TEST ORGANISMS, AND ATTACH ACUTE TOXICITY <br />TEST REPORT FORM TO DMR. <br />00105/980409 -1716 PAGE 1 OF 1 <br />