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PERMITTEE NAME/ADDRESS /Include Facihry A'nme/Lomtion ij(hgerentl <br />NAME SEHiCA COAL CC![i(iY <br />ADDRESSDkAY Ek D <br />NATOES CO tl1639 <br />FACILITY <br />LOCATION ~~ <br />.fAYGER CG_81630 <br />ATTN: G. BUG EIBOYri, "6iRSAAb 'llt~lGiH <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Furm Approved. '' <br />DISCHARGE MONITORING REPORT (OMR1 OMB NG. 2040-0004 <br />I2 f6) !'~ 19) B I N O A Approval expires 05-3t-9R ~~ <br />CCOGU(221 G11 A (SUBk II t,) <br />PERMIT NUMBER ~ OlSGHARGE NUMBER F - F 16 ! L FC ill 7 <br />MONITORING PERIOD -`ELI. PCAC GSCGE IG GFA~S] CfiB. <br />YEAR MO DAY,; ! YEAR MO DAY <br />FROM .~' iV '7'~TO 7y lA ~l q%~ hC LI _CHAFEE ) ) ~~~ <br />fzaz'7i,~rzaz3t a"-z'sr r2s-zIl rzeze) l3a3t) NOTE: Read Instructions before completing this form. <br /> '(3'r`G <br />eid(Ony) QUANTITY OR LOADING <br />~- (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER , <br />'•'ps-53) (5a-st) ~ (38-a5) (<s-53f (sa-st EX of TYPE <br />(32-37) AVERAGE MAXIMUM l1NITS MINIMUM AVERAGE MAXIMUM UNITS <br />16:431 ANALYSIS <br />(64-68f <br />69.70) <br />SGLZDS, TOTAL SAMPLE aau~azs aaaara Galsla ( ]5) <br />SUSPY;riDEU MEASUREMENT <br />OUh3U 1 0 0 PERMIT aaa~a ~ ~ ~~ eaa - ~- ;,r:+ 0 LICE/ f,FAE <br />EFFLUENT GROSS YALUY REQUiREMENr . <br />~ :aaa +~' <br />~" ~ ~H,~' O~IIi iy MG/I E;CNl11 <br /> } ~ , <br />SOLIDS, SETTLEAI?LE SAMPLE <br />MEASUREMENT ~a;:aau aaa#>~r ~ irsaaas"a ( ~`_) <br />OC745 1 U 0 "PERMIT- +PtP004? i4f)04ir!w laa ##11 ~Atf ' ~:$~~~-il ~{i/.' iFA( <br />EF <br />Y E ^ <br />~ <br />'' 1 <br />l' <br />!* rL <br />t tert6 <br />PLUE5T GROSS <br />ALUe R <br />QUIREMENT tYaa _ <br />~ ~ <br />~ <br />~ „.p <br />1 <br />3 / <br />L RON, TOTAL SAMPLE Ca9al~c ^'~X'~rr~ ~ t7ai4 <br />0a I 1 ) <br />(AS FE) MEASUREMENT <br />01041 1 0 0 <br />" <br />PERMIT ~ ii to a 0 i9":. q ii)C i m <br />> ~ "u <br />~Y+Q ' C IICe/ iBi$. <br />E.FFLUEWT likOS$ YALUE . <br />tREOUIREMENT t S><4t: ~~ Y ~`°w=~ /~ <br />_ ; <br />OIL AND GREASE SAMPLE z~vac:-'~ ^=auYt aoaa~l aaaOaL <br />". ( 15) <br /> MEASUREMENT " <br />03Sti2 1 U 0 ` <br />PERMfi >4#0948.; 4+?a4aIEE a;; AV '_' ~$ +;.. ~ C~~~' `$~$ <br />EFFLUENT GNOSS YALLE , <br />AEOUIREMENT <br />~ so:a t ~:~ ~c ~~)k5S",~i.i'~ tG/L "!`~ ~i11~,~' ~', """ ~~,:. <br />SCLID~, TOTAL SAMPLE ~c>ua~i naa%'ct an»tFta! ~ ]5) <br />DiS50LYL+D MEASUREMENT l I <br />7U2`!S 1 0 0 - <br />' PERMIT, aTrl+a!s <br />_ aas a< tas +v>rs 4~ a <br />- . 8I§Rfi7 ' -! FIrAi'r;:'. <br />EPf'LUE::1' CROSS YALLk .REQUwEMENT +~Xrt:~ ': ~ ~~ ~- 1)rlE~~ iI re/1 hv. `" <br /> SAMPLE <br /> MEASUREMENT <br /> °--PERMIT <br />EQ - <br />- <br />- ~ <br />- `r~^`-~~ <br />'~ ,.) <br />t <br />~ <br /> R <br />UIREMENT - ~ .,, ,-„_:; - <br />,~; 1 <br /> SAMPLE , <br /> MEASUREMENT <br /> tP,ERMIT i - x:~ 5 - - ; ~--- <br /> REOUIREMENT- ' ~ ~ '%~9 r ~, <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERS ONALLY EXAMINED AND <br />' <br />^ ,TELEPHONE DATE <br /> AM FAMIUAA W ITH THE INFORMATION SUBMITTED HEREIN <br />, ANO BASED ON MY <br />INOUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ` <br />\ - <br /> <br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, ~ <br />\ <br />_ <br />\ <br />:. <br />~ <br /> ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE ARE SIGNIFICANT <br />T <br />B <br />N <br />F <br />T <br />E ^ <br />_ <br />~ <br />j~`a - <br />" <br />M Y <br />'Y <br /> PENAL <br />IES FOR SU <br />MITTI <br />ALSE INFORMA <br />ION. INCLUDING TH <br />G ~ ~ ~ J <br /> POSSIBILITY OF FINE AND IMPRISONMEM SEE 18 U.S.C. 5 1001 AND 33 U.S.C. SIGNATURE OF P~iINCIPAL EXECUTIVE (f <br /> <br />TYPED OR PRINTED 5 t31B. IPanetties urger tMSe slalutes mey ulclutla lines up to Et0,W0 entl or <br />maximum imphsonment alUetween 6months entl5yeers.l OFFICER OR AUTHORIZED AGENT <br />~ A A <br />E <br />NUMBER <br />YEAR <br />MO <br />DAY <br />GUMMtN I5 ANU tXYIANAI ION UY ANY VIOLAI TUNS IHele/enCB BII aIIaCDmentE Hale) <br />TS5 L' IRON LIdI'TSrI[i NE UAZYG•C ANO SETTLYAFLE SCIIGS LICIT ABiLIEC FCB <=101B~i466 FfiECIP [YE 111= ]C°. E <br />IRON LIriITS YAIYED FCF ~lUYF,2YBk PR6CIP EYEr'T SUfJECT TC BUFGEt, 0! PFCCF Ii1 I.A.2. CI1 i GiiASE~SEE <br />EPA Form 33261 (OB-95) Previous editions may not be usetl. (REPLACES EPA FORM T-40 WHICH MAY NO7 BE USED.) G 01 Z ~/ 9 9 G E % T ~ ] 6 S j , , ~; PAGE ; OF <br />_. - - ~ _. ._ - .. _ ~ _ ~ .. - -. _ - - - ~ _.. _- :sue ~,.,,y~.,,,we... _ _ . - ,. <br />