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DocuSign Envelope ID: D07924E6-3D94-4398-AO66-B683COBAB33E <br /> Permit Narrative Conditions <br /> C O L O R A D O Division Routing <br /> Water Quality Control Division Date received <br /> C& <br /> 0epartrrcrrt❑t 1IubULc�icatth b Lnvuonmcnt <br /> Data entered <br /> PERMIT NARRATIVE CONDITIONS REPORT FORM 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 state CO Zipcode 80233-0695 <br /> Barbara A. Walz Phone 303.452.6111 <br /> Legal Contact Name Number <br /> Title <br /> Senior Vice President,Policy&Compliance/Chief Compliance Officer Email bwalz@tristategt.org <br /> Page 1 of 3 June 2019 <br />