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PERMITTEE NAME/ADDRESS <br />NAME: MOUNTAIN COAL COMPANY, LLC <br />ADDRESS: WEST ELK MINE <br />5174 HIGHWAY 133 <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 />C00038 7 76 004 W ACUTE WET TESTING FOR 004A <br />PERMIT NUMBER DISCHARGE NUMBER 4SUBR 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 />[>< <br />EX <br />OF <br />ANALYSIS <br />TYPE <br />VALUE <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 />1/90 <br />GRAB <br />QTRLY <br />GRAB <br />TAM3C 1 0 <br />EFFLUENT GROSS SEE COMMENTS <br />PEST <br />RMUIRE "T <br />SAMPLE <br />MEASUREMENT <br />PERCENT <br />LC50 STATRE 96HR ACU <br />PIMEPHALES <br />(23) <br />1/90 <br />GRAB <br />TAN6C 1 D <br />EFFLUENT GROSS SEE COMMENTS <br />KFWITNO D <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERCENT:QTRLY <br />GRAB <br />Did effluent consist of surface <br />water only for the entire <br />PERMIT <br />quarter? <br />REQLJIRE]MENT <br />NAME / TITLE PRINCIPAL EXECUTIVE OFFICER 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 THEA <br />INFORMATION THE INFORMATION SUBMITTED IS, TO THE BEST 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 />10/14/2016 <br />OFFICER OR AUTHORIZED AGENT <br />TYPED OR PRINTED <br />MM/DD/YYYY <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference a// attachments here) Forms by WlndowChem(707)864-0845,p/n11090,v5 0,1/1/96 <br />SEE LA 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 />