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PERMITEEE NAME/ADDRESS (ln Vd. FrwryNr~locaNm l/Odbm,/ <br />NAME POIILERHORN COAL COl!PAAT <br />ADDRESS ROADSID-r. ';j V;;F h ;~ ~• PO;4TAL5 <br />P.U. oJX 7 !1:) <br />PALI5AJF.' GJ a1S26 <br />FACarrv <br />LOCATION <br />A'iih: JOitt: A• .1'~Nn6F P::fiSIUENT <br />' .IIALPBAL POEL&IANfpISCNMOffE1MINATIOH EM /NRQESI - <br />_'pISC1dAflGE MONITQRING REPOR~IDMRI <br />__ 1-lel l17-191 <br />•- 000027 46 4 Y <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAV YEAR MO DAY <br />FROM U TO U 1 .'. <br />!16111 l11-131 111-151 !16171 118-191 !3631/ <br />' ~ +; Form APDroved. <br />IICOSL TIES SESSIN6ADDf}r~' -gosai-se. _, <br />(sOeR Nc) ~i°~tY~ <br />F - FIlAL <br />MINOR ' <br />1.. . <br />r <br />Fey No OISCHARC6 ~~~ ~>r>< g <br />NOTE: Rssd Instructlaru l»lors complstinp this form. <br />PARAMETER 13 6rd Onlrl QUANTITY OR LOADING II Grd Onlp QUANTITY OR CONCENTRATION NO. FREOUENCr SAMPLE <br /> !46531 l5bsll 138-~51 !0653 l5L811 <br />EX OF <br />TYPE <br />l31-371 MA<YStS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 1s1-ssl !si-581 169-701 <br />:.1: STA.TRE 48Hri AC SAMPLE >t#$~#k 40401## +~##4# #.i La;#0 ( 23) _ <br /> <br />~LitIUDAI'h NIA <br />MEASUREMENT <br />' . <br />~a n:93a 1 U ~U .: PERMIT ~: <br />,: <br />.. ~ ~ #aY#O'?E# <br /> <br />.. " ~YFCF>Gs### ++•L'4 QU ~C!QQ~ ##>6#9'V'. .##~~!#C3 .~, °BR- ~-: ~.2 AL ~'' iftlCB <br />tFPL'JEh'P LRO55 VALU . <br />:' <br />REQUIREMENT ' . #~F# iSN <br />' <br />1~1L9Z : C <br /> „ -. - <br />. <br />. .. - <br />~~SJ STATkE 96HR 'AC sAMPLE =~40C## #I~s#>a>< Oo4OS# 40#4## ~ '33) , <br />PI88PHALES ~ MEASUREMENT <br />Id:ibC 1 O .O :.:'+ R6RMIT.`?a~i'; ':.:~tRA.141~~4~/D~:: .: :"":.~~OW#I~IFAI.` •04 ~ <br />~r~ . . <br />•FFLUENT 6ROS5 VALUE REQUIREMENI ;>:'. '' .'(::,-; ,:... C y1000 ~:.':~.~ ~rE :: ~ <br />:~ . <br />:; <br />t.~. Et? ~ . <br /> SAMPLE <br /> MEASUREMENT ~ • <br /> PERMIT ~ ~ ~ ~~ <br /> REQUIREMENT ~ ~ ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~: -.:~..; ~ <br />: ' .'.r7.~~ .. <br /> REQUIREMENT _ <br />. <br />~' iE ;v<' ~. ~ .. <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT'::';.: :. .: .. . <br /> :REQUIREMENt~ <br />.. ~ ~ ~ ~ ~ ~ <br />.. , :. ~ ~ ~ . <br /> <br />,. <br /> SAMPLE <br /> MEASUREMENT - , <br /> PERMIT ~ - ~ ~ -~• <br />. REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . - ~ '. ~ ~ ~ . <br /> REQUIREMENT ~~ .. <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I cERn <br />AM FA Fr UNDER PENALTY of <br />MILIM wITN THE INFO uw rNAr I NAVE PERSONALLr ExAMINEn MD <br />RMATION SUBMITED HEREIN; MD BASED ON TELEPHONE DATE <br />r <br />r MY INQUIRY OF TNOBE INDINDUALS IMMEDIATELY RESPONSIBLE FOR <br />~• <br />' <br />~O V ~C <br />G ~l OBTNNING THE INFDRMATION, I BELIEVE THE SUBMITTED INFORMATON IS <br /> TRUE, ACCUMTE MO COMRETE. I AM AWME THAT THERE ME <br /> SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INfORMATION <br />INCLUDING ' <br />1 <br />cPY1 1 , <br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE 1B U.S.C. 1 1001 MD 33 <br />810NATUR OF PRINCMAL EXECUTNE Q J' ~Qf Q ,3 <br /> u.S.t. f tats. lnerrol.• uMr dr mnm• m.r /erA,F. n,.• R• ro 7r0.O0D <br />TYPED OR PRINTED .~dd~~ri.Ws+nwnwaw..nemmww6F.ra1 OFFICER Oq AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />~~ <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRderencs s/l attschmsnfs hare! <br />-,cE PAkT I.R.4 FUB L`ETAILS OF TtST PRUCEUURL. :IEPCRT LOYt.ST DI CUT ION (7, EFFLUF.IT) NHIC:I IS LETHAL C'0 SU:. <br />v7 TEST JitGANISMS (LCSU) AKU ATTAC4 ACUTE TUYICIT2 TEST REPCHT FORT! TC U[1R. COPIES OF ALL INFCdc`1AIIUN <br />rIJ ~,F NG' CG NT T/l i'OS- <br />EPA Form 3320.1 108-95) Previous edlnone mey be used. IREPIACES EPA FORM Ti0 WHICH MAY NOT BE USED.) U U 3 7 8 / 9 8 C 2 2 3 -12 5 o PAGE i OF <br />