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PERMITTEE NAME/ADDRESS. <br />NAME: MOUN I AIN 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: JIM D. MILLER, GENERAL MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />_C0003877 11 W JACUTE WET TESTING FOR 011A <br />PERMIT NUMBER DISCHARGE NUMBER (SUER MH) MNTRS <br />EXTERNAL OUTFALL <br />MONITORING PERIOD MINOR <br />FROM To NO DISCHARGE LX] <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/n 11090y5.0,1/1/9E <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 />00105/980409-1716 PAGE 1 OF 1 <br />QUALITY OR LOADING <br />QUALITY OR CONCENTRATION <br />PARAMETER <br />NO. <br />FREQUENCY <br />SAMPLE <br />EX <br />OF <br />TYPE <br />i <br />>< <br />VALUE VALUE UNITS VALUE VALUE VALUE <br />UNIT <br />SAMPLE <br />ANALYSIS <br />LC50 STATRE 48HR ACU <br />DAPHNIA MAGNA <br />MEASUREMENT <br />(23) <br />TAM3C 1 0 <br />PERMIT <br />EFFLUENT GROSS SEE COMMENTS <br />REQUIREMENT NO DISCHARGE <br />SAMPLE <br />PERCENT <br />OTRLY <br />GRAB I <br />LC50 STATRE 96HR ACU <br />PIMEPHALES <br />MEASUREMENT <br />(23) <br />TAN6C 1 0 EFFLUENT <br />PERMIT <br />REQUIREMENT <br />OTRLY <br />GRAB <br />GROSS <br />PERCENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME /TITLE PRINCIPAL EXECUTIVE OFFICER <br />1 CERTIFY UNOER 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 PERSONN <br />TELEPHONE <br />DATE <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 TH <br />INFORMATION, THE INFORMATION SUBMITTED IS, TO THE BEST OF M/ KNOWLEDGE AND 3EUEF, -RUE, ACCURATE, <br />Weston Norris AND COMPLETE I AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. SIGNATURE OF PRINCIPAL EXECUTIVE <br />INCLUDING THE POSSIBILITY OF FINE AND IMPRISONMENT FOR KNOWING VIOLA -IONS. <br />970-929-5015 <br />7/12/2018 <br />TYPED OR PRINTED OFFICER OR AUTHORIZED AGENT <br />MM/DD/YYYY <br />COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) Forms by WindowChem(707)864-0845;p/n 11090y5.0,1/1/9E <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 />00105/980409-1716 PAGE 1 OF 1 <br />