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PERMITTEE NAME/ADDRESS (include Facilip~Namdlocatian ijDffemay <br />NAME DL_UE i'10UNTAIN ENERGY, IINC. <br />ADDRESS~ESFRi'+DO MINE <br />3-:07 COUNTY ROAD b,°. <br />uAh!GLY rG B1.'_,48 <br />FACILITY <br />LOCATION <br />.'?hl IPCF' T`1 tAR FGT <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <br />DISCHARGE MONITORING REPORT (OMR) <br />nr~on~ n-- <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM 00 09 D! TO (70 ii9 30 <br />Form Approved. <br />OMB No. 2040-0004 <br />M I NCIR <br />I `;U~'R r~dW / <br />F - Fil'JAL. Rli i-:-PI <br />NF'-S SEP1 P7h'D T'G FtE`J '-JAShi <br />#a# f~G DISC11riR•3E I~-i A~+T <br />NOTE: Read Instructions befor mpleting this form. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br /> EX OF TYPE <br />PARAMETER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br />11'_. AND GREASE SAMPLE ###### '~$) ###>i #u r ##trA # t; +, t+#ar <br />1 Sl)AL MEASUREMENT <br />:G;~b 1 f~~ O PERMIT iIHM~1F#'1i'IF _. - :` Y _5=1 ~ ~F#4M#R dF#iFiNtx -' ###iFit* ## "-:',.1~1 EKLY Y3VAL <br />.'r FL4!i: `VT 6r+C55 VALUE REQUIREMENT ~ _ C_ (j ~ .~*~. <br /> SAMPLE <br /> MEASUREMENT <br /> ' PERMIT - r - '- ,{- ~ ~+ 'r + `-- ` ~ <br />~ ~ .. <br /> f1EQUIREIyENT - - ' _ - - ' -' ' <br /> SAMPLE <br />_ MEASUREMENT <br /> . ~~ ~ <br /> flE4DIRER9ENT w ° - - ~ <br />,' ~" <br /> <br />~. - <br /> SAMPLE <br /> MEA <br />REMENT <br />S <br />U <br /> ~ <br />b <br />p <br /> REQUIREM6t4T <br /> SAMPLE <br />- MEASUREMENT <br /> PEhMIt ~ ~ ;;~ <br />~ <br /> . <br />REQUiREMENi ~ - ~ ~ x+' <br /> SAMPLE ' <br /> MEASUREMENT <br /> s, PERMIT ~`~'*a°^`~s ~:,: •,~ ~ ~ ~ m7ge~ x <br />~ ~„ <br /> REQUIREMENT ~ ~ 7 - ~ <br />~• _ 1 . . <br /> SAMPLE <br /> MEASUREMENT <br /> -'PERMIT - ~ , . _,..: ~.. <.,~ , - .. <br /> <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER ICeniry untler penalty of law that this tlocument and all attachments were <br />' TELEPHONE DATE <br /> prepared untler my tlired~on or supemsion in acmrtlanca with a system tlesignetl <br />~~ ~ <br />d /$'~G1~ <br />7/ to assure that qualtfietl personnel prepatly gather antl evaluate the inbnnation r~~'~ <br />'r-~ <br />G(. <br />~~ submitted. Basetl on my inquiry W the person or persons who manage the system, ~e~ /~_.-+~ <br />~ <br /> or those persons tllrecgy responsible for gathering the irtlormation <br />the inloimation -' - - " <br />' <br />-i, ~ rr~ . , <br />submmed is , to the best of my knowletlge antl baliel, true, accurate, antl complete. SIGNATURE OF PRINCIPAL E%ECUTIVE `j . ".-.r' P CZ ~!i ~r- <br />TYPEq,B PRINTED lam awarethat there are signilrant penalties forsubmitting false inbrmahon, <br />inclutlin the StbJi of fne antl im risonmem br knowin Nolaaons. OFFICER OR AUTHORRED AGENT A NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />1'55 °. TJTAL IRUN LIMI7~ WILL GE WAIVED ANIi SE'TLFAI3LE 5uC iC'_ !..IM1 qF'F-'; fEP. "•^•P .=10`" ';2[(, iF' F.`JF^.i <br />5F.E I. A 2, PG V. FOR REQUIIiEMENTS OII_ & GREASF RL-PORTING-'SEE I. D. 1 I", Pr` VII !~RTRf ~ .:."!-~.~:i~lG <br />E Eor 3320- EV 9) P thou a iti fray be used. THIS IS A 4-PART FORM PAGE OF <br />