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PERMITTEE NAME/ADDRESS' <br />NAME: MUUN IAIN CUAL UUMHANY, LLC; <br />ADDRESS: WEST ELK MINE <br />51 /4 HIGHWAY 138 <br />SUMERSE I CU 81434 <br />FACILITY: WEST ELK MINE <br />LOCATION: APPX 1 MI. E. OF TOWN ON HWY 133 <br />SOMERSET, CO 81434 <br />ATTN: WESTON J. NORRIS, GENERAL MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) _ <br />C00038776 016 W ACUTE WET TESTING FOR 016A <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 c pleting 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 7 <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 <br />PERCENT <br />PERMIT <br />REQUIREMENT <br />QTRLY <br />GRAB <br />LC50 STATRE 96HR ACU <br />PIMEPHALES <br />SAMPLE <br />MEASUREMENT <br />(23) <br />TAN6C 1 0 EFFLUENT <br />GROSS <br />NO D <br />PERCENT <br />PERMIT <br />REQUIREMENT <br />QTRLY <br />GRAB <br />Did effluent consist of surface <br />SAMPLE <br />MEASUREMENT <br />water only for the entire <br />PERMIT <br />quarter? <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 />TELEPHONE <br />D A T E <br />CERTIFY UNDER PENALTY OF LAW THAT THIS DOCUMENT AND ALL ATTACHMENTS WERE PREPARED UNDER MI <br />DIRECTION GR SUPERVISION IN ACCORDANCE WITH A SYSTEM DESIGNED TO ASSURE THAT PERSONNEL <br />PROPERLY GATHER AND EVALUATE THE INFORMATION SUBMITTED. BASED ON MV INQUIRYY OTHE THE PERSON OR <br />PERSONS WHO MANAGE THE SYSTEM, OR THOSE PERSONS DIRECTLY RESPONSIBLE FOR GATHERING THE <br />INFORMATION, THE INFORIMTION SUBMITTED IS, TO THE BEST OF MV KNOWLEDGE AND BELIEF, TRUE, ACCURATE. <br />John Poulos AND COMPLETE 1 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 VIOLATIONS <br />970-929-5015 <br />1/8/2019 <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/n11090,v5.0,111/96 <br />SEE I.A.5, PP- 6-7, FOR DETAILS OF TEST PROCEDURE. LC50- STATISTICAL POINT ESTIMATE WHICH IS LETHAL TO 50% TEST ORGANISMS, AND ATTACH ACUTE TOXICITY TEST REPORT FORM <br />TO DMR. WET TESTING IS NOT REQUIRED WHEN DISCHARGE DOES NOT CONTAIN ANY MINE WATER FOR THE ENTIRE CALENDAR QUARTER. SEE I.A.a, PP3 - ALTERNATE LIMITATIONS. <br />00121/980409-1716 PAGE 1 OF 1 <br />