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PERMITTEE NAME/ADDRESS: <br />NAME: <br />MOUNTAIN COAL COMPANY, LLC <br />ADDRESS: <br />WEST ELK MINE <br />TYPE <br />P.O. BOX 591 <br />OIL AND GREASE <br />SOMERSET CO 81434 <br />FACILITY: <br />WEST ELK MINE <br />LOCATION: <br />APPX 1 MI E OF TOWN ON HWY 133 <br />84066 1 0 <br />SOMERSET, CO 81434 <br />MI 1 IN. T\CI I rl M. VVILLItAIVIJ, rMlZZ0IUCIV I <br />PARAMETER <br />SAMPLE <br />L�! <br />OF <br />TYPE <br />OIL AND GREASE <br />SAMPLE <br />VISUAL <br />VISUAL <br />MEASUREMENT <br />84066 1 0 <br />IWit. <br />EFFLUENT GROSSk <br />............ . <br />MONTH::::::::::::::::::: <br />SAMPLE <br />MEASUREMENT' <br />REQUIREMENT ; ' <br />MEASUREMENT <br />.............. <br />I�EQi:! I f�ENI EMT <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />C00038776 014 A SURFACE RUNOFF TO SYLV. GULCH <br />PERMIT NUMBER DISCHARGE NUMBER (SUBR MH) GUNIS <br />EXTERNAL OUTFALL <br />MONITORING PERIOD MINOR <br />FROM To NO DISCHARGE <br />NU I L: Keaa Instructions oetore <br />QUALITY OR LOADING QUALITY CR CONCENTRATION <br />VALUE VALUE UNITS VALUE VALUE VALUE UNIT <br />i <br />NO DISCHARGE **** <br />tnls Torm. <br />NO. <br />FREQUENCY <br />SAMPLE <br />EX <br />OF <br />TYPE <br />ANALYSIS <br />1/30 <br />VISUAL <br />MONTH::::::::::::::::::: <br />SAMPLE <br />MEASUREMENT <br />T <br />i11 <br />REQ .. I.EMEN C :' ::.::.::::: <br />NAME / TITLE PRINCIPAL EXECUTIVE OFFICER <br />CERTIFY UNDER PENALTY OF LAW THAT THIS DOCUMENT AND ALL ATTACHMENTS WERE PREPARED UNDER MY i <br />OI RECTION 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 />.INFORMATION. THE INFORMATION SUBMITTED IS, TO THE BEST OF MY KNOWLEDGE AND BELIEF. TRUE. ACCURATE, <br />Weston Norris AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, <br />INCLUDING THE POSSIBILITY OF FINE AND IMPRISONMENT FOR KNOWING VIOLATIONS. <br />TYPED OR PRINTED <br />('/INAAACAI"r AKIM CVOI AAIATIn KI !lC ANIV lllr%l ATIlIAIC <br />......... .......... <br />.... .......... <br />....... .................. ........... ­ .. . ............. ......... ..... . .... .:......... <br />....... ..... .......... . ...... ............... I .. ..................... ....... ­ ................ ........ .................. ..... . .. ................................... ..... . ....... ..........: <br />.... ........ .. ....... <br />TELEPHONE I DATE <br />SIGNATURE OF PRINCIPAL EXECUTIVE 1970-929-5015 <br />OFFICER OR AUTHORIZED AGENT <br />Forms by WindowCh <br />7/9/2015 <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.3, 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 />00154/980409-1716 PAGE 2 OF 2 <br />