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PERMITTEE NAME/ADDRESS (Include Facility Namr/Cuaarian i/Dl~errnU <br />NAME SEM~CA COAL COKFAtiT <br />ADDRESSD +~A4ER D <br />NA[DEN <br />CO b1639 <br />FACILITY <br />LocATIOI~AYDfiti CU t1LE3U <br />ATTIw: G. ADD EHCM1:, GENERAL :lAkAGEH <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR~ <br />(2 161 (I]- 9) <br />COOCO(i21 7 F <br />PERMIT NUMBER . of ARGE NUMBED <br />MONITORING PERIOD <br />YEA ,MO DAY' N~' YEAR MO DAY <br />FROM QTO y y ~ U <br />(2(1-z IJ (22?3) (' (26~2]J (2629) (3081) <br />Form Approved. <br />I ti C A OMB No. 2040-0004. <br />UH A ! F) Approval expires 05-31.98 <br />F - FI!!i ~lK111'[1 <br />L'LSCALiGE IC NUEili9~CA GU1Cd <br />0(jP '"[ISCNAFGI ~~{,j` ~.o% <br />. ~4iead Instructions beforlcompleting this form. <br /> (3 Cerd OSly5 <br />OUANTITV OR LOADING rd Only) ~ QUANTITY OR CON TRATPOtJ NO. FREOUENC SAMPLE <br />PARAMETER 3 <br />( ) (54-61) (38-45) (46 53) (54-61) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANaLYBIS <br /> (6z~W} (64-68) 69-70 <br />U L SAMPLE I `? I A CrI »: ~~:%% <br />Y I.`iU & L MEASUREMENT <br /> <br />84U6b 1 U 0 <br />~~ ~ ~~ FE=1 C+pL <br />i <br />hFF'LUENT GKOSS YALUE UI(~E<~kT'-- <br />~ ~ <br />r <br />. <br />^> ~ .; ~~ ~- ;~ ~ : <br /> - <br /> SAMPLE <br />r MEASUREMENT - <br /> r.. ; <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> r a;' <br />~ MIT: +. , <br />~ <br />,: <br />'.:`+ <br />r f (,- <br /> ~~ar~~rxr ~ <br />~ . , + , I ~~. <br /> ,. <br /> SAMPLE <br /> MEASUREMENT ' <br /> ~ ~ ~ <br />ham, <br />~ ~. <br />j ~~ <br />S x <br />` <br />'1r R-' <br />`~ <br />' <br />x <br />~Y <br />,~, <br /> E)~QUfRiMfNT yy <br />` " } - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> ~~ <br />~ ~ ~~ c <br /> , <br />ENT <br />~~ISdIkIk~1 ~ ""~ <br />` <br /> , . S <br />NAME/TITLE PRINCIPAL IXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THgT I HAVE PERSONALLY EXAMINED AND <br />ATION SUBMITTED HEREIN <br />AND BASED ON MY TELEPHONE DATE <br /> INQUIRY OF THOSE INDNIDUAL ; <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEV E THE SUBMITTED INFORMATION IS TgUE, <br /> <br />' ACCURATE AND COMPLETE. <br />PENALTIES F <br />R <br />B <br />TT I AM AWARE THAT THERE ARE SIGNIFICANT <br />F <br />F ' <br /> MI <br />ING <br />O <br />SU <br />POSSIBILITY OF FINE AND IMPRI ALSE IN <br />ORMATION, INCLUDING THE <br />SONMENT. SEE 18 U.S.C. § 1001 AND 33 U.S.C. <br />SIGNATURE OF PRIN AL EXECUTIVE /~ <br /> <br />TYPED OR PRINTED 4 t3t9 (Penehies untler these smrutes may inclutle lines up to EI0,000 entl or <br />maximum imprisonment of behseen6monrhs entl5yeers.) OFFICER OR ALIT RIZED AGENT <br />~ <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND E7(PLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />TES S IKON LIlIITS PILL dE YAIYEC 6 St.'TTLEANLE SCL]CS LIrtIT APPLIEC FOF C=1{%Y A,24EF. FFEGIi ~lYEN9; 795 G <br />IRON Li~ITS MAIYED FCF >lUFH,24MH PAECIP EVENT SUEJEC2 7G BUHDEN OF F6CCF SN I.A.T. GII d GFiA:E - SEE <br />i N_ln TnC Yr Y'r Rf clYC r_o 1 C <br />EPA Form 33247 (OS-96) Previous editions may not be used. - (REPLACES EPA FORM 7-40 WHICH MAY NOT BE USED.) QO 1911/ 99A~3'#'_ Y6 ~ 3 PAGE ~ OF <br />