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PERMITTEE NAME/ADDRESS (Include Facilin•NamrlLOOalion JDiJjerentl <br />NAME SkAcC0. COAL CCffIN't <br />ADDRESSDRANEN D <br />BAiDEK CO 41639 <br />FACILITY <br />LOCATION) A Y D Z M <br />A7TN: G. BUD PNOYN, <br />NATIONAL <br />CO 81 E 30 FROM <br />CENEicAL MANAGER <br />(NPDES) <br />RANT DISCHARGE ELIMINATION SYSTEM <br />AR GE MONITORING I <br />REPORT (OMR79) <br />121 a14 Y <br />NUMBER DISCHARGE NUMBER <br />(2E21) (2a~291 (309/) <br />nLt,cN <br />~sD~e ~r) <br />F - FIAIi <br />Form Approved. <br />OMB No. 2040-0004 <br />Approval expires 05-31-98 ~ 3 <br />FC{~:T 7 <br />ACUTE Ii E1 tE_'t11C ~EfCF C14A <br />:~~ hL [I.ChAbCI: {2S{ ~~~ <br />NOTE: Reatl Instructions before completing this form. <br /> (3 Cartl Ony) QUANTITY OR LOADING ~<~Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4fi-53) (54-61) '~]~ p (38-45) 46-59) (54-67) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />(6263) ANALYSIS <br />(64 66) <br />(69-70 <br />Ll.]U S[A7 ttL VOUtt AlU SAMPLE +'a "A`/+A'+'` vaaa>Ra +:.aaaaa aai+aA i ~~~ <br />CERIOUAPMNIA MEASUREMENT <br />TAM3ii 1 U U PERMIT °~9` ' '~=• - a~x k~~. ~ i <br />~ kF- ( T6L1 '61E <br />EFPLUEN7 GROSS YALDE REQUIREMENT ~``*~ p er' <br />t ~>ox# ~F ~ ;~ ~ `' CEh7 <br /> S 4Y <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _. s ~,. ~ ...~ ~ aP o .. - <br /> REOUIREMENT - ~ - z -~„'',y, *q~~• &~ ~ :, <br />t~ ~a <br /> SAMPLE ~ -~'~~". ~~' ~~ <br /> MEASUREMENT ,c, ..~.>S r,. . <br /> ,PERMIT - „~~ '-`i ', - <br />~ <br />: <br />.. <br />- ~~ -,~ <br /> REQUIREMENT - r _ <br />-, . r~-. ` <br />i <br /> <br />- ~ <br />z.. , .. <br /> SAMPLE ~" '~ <br />~ <br /> MEASUREMENT ~ ; <br /> ~" -` PERMIT- ~ t_ ' ` •~ <br />-"r <br />" F. iw.; ~ ~ • <br />d <br /> . <br />' <br />~ ~ y <br />~ <br />' <br />" ~ g <br />. <br /> REQ-UIREM~ENT - ~ ~_~ ~°~~ ~ <br />>;~,' - <br /> SAMPLE <br /> MEASUREMENT ~. '~ <br /> <br />~ <br />° <br />= <br />~ <br />~ <br />sF ~ ~: <br />. <br /> REQUIREMENT .,.. <br />. <br />'i <br />A;## y~ <br />.~* ~ 'ia <br />~a....- ,. rz, ~s~ <br />a _ , a <br /> SAMPLE <br /> MEASUREMENT <br /> 'PERMIT: ~ ' ~ `;) , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ':PERMIT - ^1= <br /> 'REQUIREMENT <br />~ :. <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERS ONALLY EI(AMINED AND TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY <br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br /> ACCURATE PND COMPLETE. I AM AWARE THAT THERE AAE SIGNIFICANT /., ~.~ O I <br /> PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING THE / <br />^ <br />7 <br /> POSSIBILftY OF FINE AND IMPRISONMENT. SEE to U.S.C. § toot AND 33 U.S.C. SIGNATURE OF PRIN IPAL EXECUTIVE V <br />\/ <br /> u~sirres uprof10,000 end or <br />e <br />lmp <br />m <br />e <br />m <br />+ <br />~ <br />~ OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED nd S <br />imum <br />an <br />ol bsMeen6m <br />onths <br />a <br />ns <br />e <br />GUIdMtN I S AND tXHLANA I IUN OF ANT VIULA I IUNJ (HelelerlCe al/ artaLnmen(S nere) <br />SEE BART I. A.4 FCii CE7AIL:3 OF TEST ~ROCEDUAF. AEICET LCNkSI DIIUTICN ~; EE'FLUEDI) YNICC ]S I~..7N11 7C `_0: <br />OF TEST ORGANISMS (LC~U) ANll ATTACH ACUTE TCXICITI TEST AEPCAT FCirN TG GA&. <br />EPA Form 3320.1 (OS-95) Previous editions may not be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) PAGE OF <br />OU1b7/996E27-1653 1 <br />