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PERMITTEE NAME/ADDRE$$(lnc(ude Faoilirv Name/Cocanon ifDijferenq Np <br />NAME seN~c~ COAL CC!!F/HY <br />ADDRESSD N A y£ H D <br />hALDBN CO ".1.39 <br />~~~ . <br />FACILITY <br />LOCATIOPJ{ A T ll E N 0 8 j 6 .i U <br />FROM <br />A'tTti: v. but. i•hcl;lti. GENE M~N~6FA <br />DNAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) ', Fofm AppfOYed. , ,~ <br />DISCHARGE MONITORING AEPORT /DMA OMB No. 2040-0004 <br />.tz vsl (n-;e/ M I K ~ ~ Approval expires OS-31-98 <br />' NUMBER ~ ~ HARGE NUMBER P - 11 1 A l FlagyT T <br />MONITORI PERIb ~' LI.,CtiAECE TC $~~i4 CilFll <br />YEAR MO DAY YEAR MO DAY <br />rzn 2n rm~-~~~ r~a.ni rzazsi t.Tp en NOTE: Read InsfmctiliNSbefore. olnpletinp this form. <br />PARAMETER (3~iardOnty) QUANTITY OR LOADING bOnty) bUANTII'Y OR CONCENTRATIO :. ~CREQUENC SAMPLE <br /> - , (4E53) (54-61) <br />iv <br />~ (38-05) (4653) {54-6T) OF TYPE <br />(32-37) -,. <br />, <br />- .V~9AGE <br />MAXIMUM <br />UNI <br />MINIMUM <br />AVERAGE <br />~ MA%IMUM <br />UNITS <br /> <br />rsas~) ANALYSIS <br /> <br />(s4-sa) <br /> <br />ss-7o <br />L A D LH SAMPLE ?h#~ ( ?4) ???A>•S K~Lri 4~1+" >} ~t>SCA <br />VISUAL MEASUREMENT <br /> fi <br />buUu6 1 0 9 ¢Cii 4T ~` p ,l9=1 ~:~ ' CAi / ~ .# <br />E:FE'LOEHT ~kOSS EALOE ;R~QI~'. ~NT ~~ U " ~ << <br />„" ,:~ 0>OCA ` EC, <br />Y31i ~" <br /> ~ , -.~ . . <br /> SAMPLE <br /> M REMENT -~ <br /> ,~ <br /> " .~ <br /> <br /> SAMPLE <br /> MEASUREMENTJ I'~ ' <br /> - PERMIT ~ '" `~ ' ' ~ " . - - ~ t ~; -- <br /> '~' <br /> SAMPLE <br />• ~ MEASUREMENT '`r <br /> <br /> ,' ;PE ' ~~ ,tea IIJ" i "" <br /> fA6MENT „ <br />,. ~, <br /> <br /> SAMPLE <br /> MEASUREMENT ' <br /> r <br /> .P E~~Glll"• :trig`": <br /> :REQUIREMENT ,~ " <br /> SAMPLE <br /> MEASUREMENT <br /> --`PE,{~MIT- - r <br /> A~~~IREMENT ~ e - <br />-;y~ ,; ' <br />, <br /> - ~ <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> ,..PENMIT. _ i,~. ~" <br /> <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF'i <br />AM FAMILIAR WITH THE INFORM •AW THAT I HAVE PERSONALLY E%AMINED AND <br />ATION SUB <br />TED HEREI <br />B <br />SED <br />' TELEPI'IONE DATE <br /> MIT <br />. AND <br />A <br />ON MY <br />N <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING THE <br /> <br />, <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE tR U.S.C. g t Wt AND 33 U S C. <br />" <br />SIGNATURE OF PRI CIPAL E%ECUTIVE ~~ ~ ~ ' <br /> Ude lines up lp ft0.0oo end or <br />~ <br />m <br />m <br />m~ <br />~ <br />o <br />h A <br />TYPED OR PRINTED r <br />u <br />~ <br />smme <br />ol <br />a <br />oyes n6 montrts anC S <br />pd ymrs.) OFFICER OR AUTHORIZED AGENT <br />r D NUMBER YEAR MO DAY <br />wmmtn I a Hnv cnrl.vnv, I IUrv Ur nrvT vwla I I~rvs (rrererence an arracnmenrs nere) <br />TSS E IHOM LIHITS GLIL BE YALYLC E SETTLF.ARLE gCL1C5 LIB1T AFFLIEC FC6 <-lUYd,i4HF FHECIF EYEIIT; T'_S E <br />EiETTLBAHLfi SOLLUS IIlLT yAIVE.D PUF >l0YH,24HH PAECLF FPFM1 SGEJEC 'IC EOhCEN CP LE,CCY I~ ].l.i• GIL E <br />r-BF•SF - cpp I_w.1=[ +nc ^nRrRn cTluc _ cPly r w 7 c <br />EPA Form 3320-7 (08-95) Pfevious editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) DA 17 3~/ 9 y C 6 i ~ ~ S ~ ~ ,3 ~ PAGE 1~ OF <br />