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PERMITTEE NAME/ADDRESS (Include Faailiryh'ame/Gocanan JDijjerenq
<br />NAME CYk'HUS YAHE'A YALLf'Y COAL CiTRP.
<br />ADDRESS•{jH~.~ 1r 1S3 SUUTHr 7; E:CKC P.h 'r%
<br />y1UU tA:,T f1IHi:HRL CIRCLE
<br />i'.2;GLr:YOCD CO BU1S:
<br />FACILITY
<br />LOCATION
<br />AT'LY: ~:uHdIS w. ncGLtY, Gti'XEYAL ATHY
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMq
<br />(1461 /IT.(9)
<br />COU@17 S f)Or: A
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM it UY V 7p UJ Vy JU
<br />(20.211 R2~237 (2d-251 (26~2T1 (2828) f3031J
<br />Form Approved.
<br />f9 A J O R OMB No. 2040-0004
<br />Approval expires 05-31-98
<br />(SUfl.: Kw)
<br />F -T'IiIAL NULT!'
<br />`I1kF 1, PC'lG is "_C FGIDFL CHF.Ed
<br />NOTE: Read Instructions before completing this form.
<br /> (3 Card Only) QUANTITY OR LOADING (<Caro'Ony) QUANTITY OR CONCENTRA710N NO, fREOUENC SAMPLE
<br />PARAMETER (4653) (54-61) (36-45) (4653) (54-61) EX OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />/62c31 ANALYSIS
<br />/fia-68)
<br />69-70
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<br /> MEASUREMENT ~ NA ~-~'a ,~A- IIJR ~~ ~{}
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 CERPFY UNDER PENALTY OF LAW THA71 HAVE PERSO NALLY E7UMINED AND TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFORM ATION SUBMITTED HERE AND BASED ON MV
<br />IN
<br />Richard Ib1II IS INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON .
<br />SIBLE FOR OBTAINING
<br /> THE INFORMATION, I BELIEVE THE SUBMITTED IN FORMATION IS TRUE,
<br />Environmental Mana er ACCURATE AND COMPLETE. I AM AWARE THAT TH
<br />PENALTIES FOR SUBMITTING FALSE INFORMATI ERE ARE SIGNIFICAM
<br />INCLUDING THE
<br />ON
<br />'~
<br />970-870-2712
<br /> ,
<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1a U.S.C. 41001 AND 33 U.S C.
<br />§ 1319
<br />(Penal(res under These sreMes ma
<br />Include rmes u
<br />ro T 10
<br />Q70 arM or _
<br />SIGNATURE OF PRINCIPAL EXECUTIVE GYt7 ~L~ a
<br />
<br />TYPED OR PRINTED ,
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<br />maximum impdsonmenr or beMeanBmonrhs end5years
<br />) OFFICER OR AUTHORRED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br /> . ODE
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />,L'i?nV(1':E LIMITS FOh T55 & SGTTLEA;iLE 5GLID-'. (LOC 'O') APPLY OILY 1}' C= 17-Y!, 24-US [!;ECli LSE!•I IS
<br />~LAIM.p, ~='E.' 1. A. 2, PG 1H, FOfi isUZDEN OF P$O+iF ~F.QUIREMEt•'"'~. DIL L GP~:'~i--_ -,,,, ;~,_ /~ ,~;; ~~
<br />EPA Form 3320.1 (08-95) Previous editions may not be usetl. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) I„f PAGE I OF
<br />00'_x:/ C405-1:i~i
<br />
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