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PERMITTEE NAME/ADDRESS pndude Faailiry.Nume/Lxarron i/Dtj/ereny <br />NAME ~gpgCA COAL CClE/BI <br />ADDRESSDh AYEk U <br />HAYDEN <br />CO 81639 <br />FACILITY <br />LOCATIONdAYDEI. CO e1630 <br />BTTti: G. tlUU dxOYN, Gf.:ERAL ttAAli!,GEk <br />NATIONAL POLUJTAM DISCHARGE ELIMINATION SYSTEM (NPDESI <br />DISCHARGE MONITORING REPORT (OMRJ <br />(z401 (t] 91 <br />CCOUCC721 C 7 A <br />PERMIT NUMBER ,.~ 'DISCHARGE NUMBER <br />FROM <br />(26ztj `?:T2~'-231. (1d-251 (z6~zll (z3~z9) 13031) <br />~:, <br />" ~ MONITO <br />RING PERIOD <br />VEd9 <br />~,~', _ <br />. MO DAY 'YEAR <br />;;,,,~V Vi~ p 77 MO <br />is DAY <br />-11 <br />Form Approved. ' <br />C I IG C P. OM8 No. 20400004 '~ <br />Approval expires OS-3t-98 '!, <br />(SU68 11i) <br />f - fIMAL BAf9YT <br />OISCII>f.1i! TC "SlGE CEEPP <br />}.. <br />t3PCNA-6~1' ~( 10>1K <br />OTE: Reatl~lnstruclions beforl.~dompleting this form. <br />~~~ - <br /> (3 Card Onry) QUANTITY OR LOADING`. <br />` I<Card Onty) QUANTITY OR CONCENTRATION ~.;`s:~" NO. PREOUENC SAMPLE <br />PARAMETER (4653) (54-611 ~ (3a~45) (4s-53) (5r-sT/ I , ;, EX OF TYPE <br />(3z-37J AVERAGE MAXIMUM U~ MINIMUM AVERAGE MAXIMUM~~ f~I UNITS.. S <br />A~ <br />m 69 <br />70 <br /> rsz ~l sa) <br />e - <br />) <br />( <br />U L AAU GkF.ASC SAMPLE VaOCr~a ( 9U) 09Aii0 L051 sIOD .~A9O fir} , <br />V L S U A L MEASUREMENT <br /> ~r <br />if4i)06 1 U 0 .PERMIT <br />, <br />~:~} > ~ IS=] ~ ilOti V>aV 4 i L`AL ~ <br />.' .II~Dl~L <br />ti'FLUENT Gk05S YALUE REQUIREMENT r s ~ ` ~'- h , <br /> _ <br /> SAMPLE is 1 a.:r.;'~~'. ~ "Y ~In.: <br />~ <br /> MEASUREMENT ,~ ~ <br />: <br /> PERMIT - -- '*;~-' .; ~ -. 't y . <br />L <br /> REOUIFiEMENT ~~ ' ~~_" ~„~`~j.,' r <br />~~~*.. " <br />: I+'rr~{~_. <br /> SAMPLE <br /> MEASUREMENT i` ~ <br />,,.," - <br /> =-PERMIT- - <br />l -" <br /> <br />f ". <br /> <br />.. <br /> <br />"" r a, A <br /> <br />v <br />r <br />T`" ; o <br /> <br />~ ~ <br />~ `,~ r+ <br />~4 - _ v. <br /> REQUIREMENT <br />I ~'' „ <br />/ <br />.... ~. n ' <br />_ <br />x] E.s ~ <br />.-I <br />e " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ; r - t.~ <br />" ~f "b i <br />~ , ~'6 '~;fjf " .~ <br /> `REQUIREMENT ' " - - 's: ` I " <br /> S <br /> AMPLE <br /> MEASUREMENT <br /> - ~ PERMIT ~ +'~=y'''" <br />~ <br />~ ''~p.wo s. ~-'~ <br /># <br />r ~ titz i "Y- <br />~ <br /> REQUIREMENT ',. - - . <br />3 <br />^ ` ? 7 ` ,. <br />.. .._:. _ , ~, ~ `. <br /> <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT` <br />~ <br />~ ~ ~ ;~ ~ „.r^ i $'.: <br /> 'REQUIREMENT' _ <br />- ~ #*'a - ~.~N ~:. ~~". <br /> _ .. , ,i t Ai z <br /> SAMPLE <br /> MEASUREMENT <br /> 'FPERMIT <br />~` <br />~ ~ ''' ` <br />~ <br />- <br />' ~ x - <br />"~- <br /> REQUIREMENT _ = <br />: <br />- <br />-Try .~ ,; ~ <br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WRH THE INFORM LAW THAT I HAVE PERSO <br />ATION SUBMf7TED HER NALLY E%AMINED AND <br />AND B <br />ED ON M <br />EIN TELEPHONE. DATE <br /> <br />INQUIRY OF THOSE INDIVIDUAL ; <br />AS <br />Y <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />- <br /> THE INFORMATION, I RELIEV E THE SUBMITTED INFORMATION IS TRUE. <br /> ACCUNATE AND COMPLETE. <br />PENALTIES FOR SUBMITTIN IPM AWARE THAT THERE ARE SIGNIFICANT <br />G FALSE INFORMATIO <br />INCL <br />ING T L <br /> <br />N, <br />UD <br />HE <br /> <br />r ~ O ' <br /> POSSIBILDY OF FINE AND IMPR ISONMEM. SEE 1R U.S.C. 4 10(11 AND 33 U.S C. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 5 t310. IPenetties under These sierurps m4Y include lines up to 510,000 end w <br />TYPED OR PRINTED miximum imprisonment of belween6mpnlhs endsyeem.) OFFICERO~NORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here) ~ . ` <br />TS:i A IAON LL17IT5 x111 B6 YAIYEC S SBTTLEAHLF SCLFCS LIdI2 APF[I!D -CF <=l0Yk,14EE FkECIF EYEMT; 2`_5 6 <br />[AOA LIlIZTS YAIYeD FCF ~lUTR,L4Rk PRYCIP 6YEYT SUEJECT 7C BONO~M CF P6CCP IM I.A.2". CIj L GTIEA_E~- .EE <br />T u r n 9flC Mr?b1TPC~tl r' i o 'r c ' <br />EPA Form 33241 (OS-95) Previous editions may not be used. T ~ (REPLACES EPA FORM T-40 WHICH MAY NOT.BE.USED.) 60137 f 44 Q e,~ ~~,4 ~ ~ ~ "PAGES OF <br />