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PERMITTEE NAME/ADDRESS. <br />NAME: <br />MOUNTAIN COAL COMPANY, LLC <br />ADDRESS: <br />WEST ELK MINE <br />5174 HIGHWAY 133 <br />PARAMETER <br />SOMERSET CO 81434 <br />FACILITY: <br />WEST ELK MINE <br />LOCATION: <br />APPX 1 MI E OF TOWN ON HWY 133 <br />SAMPLE <br />SOMERSET, CO 81434 <br />ATTN: JIM <br />D. MILLER, GENERAL MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />C00038776 004 W 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 <br />NOTE: Read instructions before completing this form. <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) Forms by WindowChem(707)864-0845;p/n11090;V5.0;1/1A6 <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 />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 />TAM3C 1 0 <br />EFFLUENT GROSS SEE COMMENTS <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERCENT <br />OTRLY <br />GRAB <br />LC50 STATRE 96HR ACU <br />PIMEPHALES <br />(23) <br />1/90 <br />GRAB <br />TAN6C, 0 <br />EFFLUENT <br />EFFLUENT GROSS SEE COMMENTS <br />PERMIT <br />REQUIREMENT NO D <br />SAMPLE <br />MEASUREMENT <br />PERCENT <br />OTRLY <br />GRAB <br />Did effluent consist of surface <br />Water only for the entire <br />PERMIT <br />quarter? <br />REQUIREMENT <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER TELEPHONE <br />DATE <br />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 MV 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 />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 KNOWINGVIOLATIONS SIGNATURE OF PRINCIPAL 970-929-5015 <br />10/5/2017 <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/n11090;V5.0;1/1A6 <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 />