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DocuSign Envelope ID: EBE28081-13782-41342-BAD13-D8C9313687131B <br />COL.ORADO <br />Water Quality Control Division <br />Oepartrrcrrt ❑t 1IublrC � icatth b Lnvuorimcnt <br />PERMIT NARRATIVE CONDITIONS REPORT FORM <br />Permit Narrative Conditions <br />Division Routing <br />Date received <br />Data entered <br />Permits Reviewed <br />Enforcement Reviewed <br />Engineering Reviewed <br />Please print or type all information. <br />You must use this form whenever you are submitting any documents to the Water Quality Control Division <br />(besides permit modification applications and annual reports) that are required by your permit, including <br />documents you are submitting to comply with items listed in your permit's compliance schedules or any other <br />reports or Special Studies required by your permit. <br />All items must be filled out completely and correctly. <br />Colorado Dept of Public Health and Environment <br />Water Quality Control Division - Records <br />4300 Cherry Creek Dr South WQCD-P-B2 <br />Denver, CO 80246-1530 <br />MAIL ORIGINAL FORM WITH INK SIGNATURES TO THE FOLLOWING ADDRESS: <br />FAXED or EMAILED FORMS WILL NOT BE ACCEPTED. <br />PART A. IDENTIFICATION OF PERMIT Please write the permit number <br />PERMIT NUMBER CO-0045161 <br />TYPE OF PERMIT (Check as many as apply): <br />Individual Permit <br />Domestic Wastewater Treatment Facility Discharging to Groundwater_ <br />Domestic Wastewater Treatment Facility Discharging to Surface Water <br />Industrial/MiningX <br />Dewatering <br />Other (Please describe) <br />PART B. PERMITTEE INFORMATION (form should be signed by the legal contact listed here) <br />Company Name Colowyo Coal Company L.P <br />Mailing Address P.O. Box 33695 <br />City Denver <br />Legal Contact Name Barbara A. Walz <br />Title Senior Vice President, Policy & Compliance/Chief Compliance Officer <br />State CO zipcode 80233-0695 <br />Phone Number 303.452.6111 <br />Email bwalz@tristategt.org <br />Page 1 of 3 June 2019 <br />