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DocuSign Envelope ID:6BC32598-B737-464E-898A-81 F1 F7131339133 <br /> Permit Narrative Conditions <br /> C O L O R A D O Division Routing <br /> Water Quality Control Division Date received <br /> NW AC Department of Public Health&Environment <br /> Data entered <br /> PERMIT NARRATIVE CONDITIONS REPORT FORM Permits Reviewed <br /> Enforcement Reviewed <br /> Please print or type all information. <br /> You must use this form whenever you are submitting any documents to the Engineering Reviewed <br /> Water Quality Control Division (besides permit modification applications and <br /> annual reports) that are required by your permit, including documents you are <br /> submitting to comply with items listed in your permit's compliance schedules or <br /> any other 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 /> TEMPORARY COVID19 Submission - Instead of mailing the form with a wet signature, <br /> you may email a digitally signed form to: <br /> cdphe.wqrecordscenter@state.co.us. <br /> Do not follow up with a mailed-in hard copy. <br /> The directions for electronic signatures can be found at this FAQ at question 41. <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/Mining <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 /> Legal Contact Barbara A. Walz Phone <br /> Name No. 303.452.6111 <br /> Title SVP, Policy&Compliance/Chief Compliance Officer Email bwalz@tristategt.org <br /> Page 1 of 3 October 2021 <br />