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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 />4 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 0 <br />NOTE: Read instructions before completing this form. <br />PARAMETER <br />QUALITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FREQUENCY <br />SAMPLE <br />VALUE <br />VALUE <br />UNITS <br />VALUE <br />VALUE <br />VALUE <br />UNIT I <br />[>< <br />EX <br />OF <br />ANALYSIS <br />TYPE <br />LC50 STATRE 48HR ACU <br />DAPHNIA MAGNA <br />SAMPLE <br />MEASUREMENT <br />(23) <br />1/90 <br />GRAB <br />TAM3C 1 0 <br />EFFLUENT GROSS SEE COMMENTS <br />PERMIT <br />F{EQtll♦ZENiFN7 <br />SAMPLEMENT <br />MEASURE <br />PERCENT <br />C2TRLY <br />GRAB <br />LC50 STATRE 96HR ACU <br />PIMEPHALES <br />(23) <br />1/90 <br />GRAB <br />TAN6C 1 0��MI <br />EFFLUENT GROSS SEE COMMENTS <br />REQUIREMENT NO D <br />SAMPLE <br />MEASUREMENT <br />PERCENT <br />t .. . <br />.. aAf <br />Did effluent consist of surface <br />water only for the entire <br />gQutFnl <br />.T. . <br />NAME / TITLE PRINCIPAL EXECUTIVE OFFICER TELEPHONE <br />DATE <br />11 CERTIFY UNDER PENALTY OF LAW THAT THIS DOCUMENT AND ALL ATTACHMENTS WERE PREPARED UNDER MYi <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 jot:�76, <br />PERSONS WHO MANAGE THE <br />SYSTEM, OR THOSE PERSONS DIRECTLY RESPONSIBLE FOR GATHERING THE <br />INFORMATION, THE INFORMATION SUBMITTED IS, TO THE BERT OF MY KNOWLEDGE AND BELIEF, TRUE, ACCURATE, <br />.AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. <br />Weston Norris INCLUDING THE POSSIBILITY OF FINE AND IMPRISONMENT FOR KNOWING VIOLATIONS. SIGNATURE OF PRINCIPAL EXECUTIVE 970-929-5015 <br />7/6/2016 <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 WindowChem(707)864-0845;p/nllO90;v5.0;l/7/96 <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 />00017/980409-1716 PAGE 1 OF 1 <br />