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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 />ATTN: KEITH R. WILLIAMS, PRESIDENT <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />ACUTE WET TESTING FOR 004A <br />PERMIT NUMBER DISCHARGE NUMBER (SUBR MH) GUNIS <br />EXTERNAL OUTFALL <br />MONITORING PERIOD MINOR <br />FROM To NO DISCHARGE Ox <br />NOTE: Read instructions before c mpleting this form <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) Forms by VVindowChem(707 )864- 0845;p1n11090;v5.0;111196 <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 />00017/980409 -1716 PAGE 1 OF 1 <br />QUALITY OR LOADING <br />QUALITY OR CONCENTRATION <br />PARAMETER <br />>< <br />NO. <br />FREQUENCY <br />SAMPLE <br />VALUE <br />VALUE I <br />UNITS <br />VALUE <br />VALUE <br />VALUE <br />UNIT <br />EX <br />OF <br />ANALYSIS <br />TYPE <br />LC50 STATRE 48HR ACU <br />DAPHNIA MAGNA <br />SAMPLE <br />MEASUREMENT <br />I <br />(23) <br />1/90 <br />GRAB <br />TAM3C 1 0 <br />EFFLUENT GROSS SEE COMMENTS <br />; <br />j <br />PERCENT <br />PER�1iELr;;;; <br />A 1iI��Ni�N f <br />.. .........:.:.................:� <br />::::;::::::: <br /><2j R1Y�RAB <br />::::::::::::::::::::::::::::::: <br />LC50 STATRE 96HR ACU <br />PIMEPHALES <br />SAMPLE <br />MEASUREMENT <br />(23) <br />1/90 <br />GRAB <br />TAN6C 1 0 <br />EFFLUENT GROSS SEE COMMENTS <br />NO DISCHARGE <br />i <br />PERCENT::: <br />`pRMl:.t::::::::: <br />REfiL11fZENIEfJ [ <br />: ::::::::::::::::::::::::::::::: <br />2TR <br />F21?I3 <br />Did effluent consist of surface <br />SAMPLE <br />MEASUREMENT <br />water only for the entire <br />quarter? <br />iQUFIN7 { <br />I <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER ' <br />TELEPHONE <br />DATE <br />I CERTIFY UNDER PENALTY OF LAW THAT THIS DOCUMENT AND ALL ATTACHMENTS WERE PREPARED UNDER <br />DIRECTION OR SUPERVISION IN ACCORDANCE WITH A SYSTEM DESIGNED TO ASSURE THAT QUALIFIED PERSONNEL <br />PROPERLY GATHER AND EVALUATE INFORMATION <br />THE SUBMITTED. BASED ON MY INQUIRY OF THE PERSON OR <br />.PERSONS WHO MANAGE THE SYSTEM, OR THOLE PERSONS DIRECTLY RESPONSIBLE FOR GATHERING THE <br />'.INFORMATION, THE INFORMATION SUBMITTED IS, TO THE BEST OF KNOWLEDGE AND BELIEF, TRUE, ACCURATE, <br />�'.ANO COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, <br />Weston Norris INCLUDINGTHE POSSIBILITY OF FINEAND IMPRISONMENT FOR KNOWING VIOLATIONS. <br />SIGNATURE OF PRINCIPAL EXECUTIVE 970 - 929 -5015 <br />4/21/2015 <br />OFFICER OR AUTHORIZED AGENT <br />TYPED OR PRINTED <br />MM /DD/YYYY <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) Forms by VVindowChem(707 )864- 0845;p1n11090;v5.0;111196 <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 />00017/980409 -1716 PAGE 1 OF 1 <br />