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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: KENNETH COCHRAN, PRESIDENT
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />C00038776 013 V--JACUTE WET TESTING FOR 013A
<br />PERMIT NUMBER D SCHARGE NUMBER (SUBR MH) GUNIS
<br />EXTERNAL OUTFALL
<br />MONITORING PERIOD IMINOR
<br />FROM TO NO DISCHARGE
<br />NOTE: Read instructions before completing this form.
<br />PARAMETER
<br />QUALITY OR LOADING
<br />QUALITY OR CONCENTRATION
<br />NO.
<br />FREQUENCY
<br />SAMPLE
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<br />OF
<br />ANALYSIS
<br />TYPE
<br />VALUE
<br />UNITS
<br />VALUE
<br />VALUE
<br />VALUE
<br />UNIT
<br />LC50 STATRE 48HR ACU
<br />DAPHNIA MAGNA
<br />SAMPLE
<br />MEASUREMENT
<br />(23)
<br />TAM3C 1 0
<br />EFFLUENT GROSS SEE COMMENTS
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<br />NAME / TITLE PRINCIPAL EXECUTIVE OFFICER
<br />I 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 BATHER 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 TME
<br />Weston Norris INFORMATION, THE INFOFORMATION SUBMITTED IS, TO THE BEST OF MY KNOWLEDGE AND BELIEF, TRUE, ACCURATE,
<br />AND COMPLETE I ANIAWARE THAT THERE ARE SIGNIFICANT PENALTIES R SUBMITTING FALSE INFORMATION,
<br />INCLUDING THE POSSIBILITY OF FINE AND IMPRISONMENT FOR KNOWING VIOLATIONS
<br />TELEPHONE
<br />SIGNATURE OF PRINCIPAL EXECUTIVE 970-929-5015
<br />DATE
<br />4/21/2016
<br />IMM/DD/YYYY
<br />TYPED OR PRINTED
<br />OFFICER OR AUTHORIZED AGENT
<br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) Forms by WmdowChem(707)864-0845,p/nI 1090,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 />00145/980409-1716 PAGE 1 OF 1
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