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PERMITTEE NAME/ADDRESS pndude Fanlirv Name2xarian fD~erenq <br />NAME S.Yc:CA COAL CCrFAH1! <br />ADDRESSD R A it E P- D <br />HaTDSfa co B1ti39 <br />FACiuTv <br />LOCATIOI~~YLEN CC 816.30 <br />FROM <br />A7'Thi r:, rIUU HitUwN, GE~:EHAL I'fAHAGEA <br />NINATION SYSTEM (NPDES) <br />REPORT (OMR1 <br />(n-797 <br />DISCHARGE NUMBER <br />(20.21) (1223} - ~'~ (Z6-2]) (29-291 (3031) <br />Form Approved. <br />:' I NG K OMB No. 2040~OOQ4 <br />(S U 8 R /I Y) /+PProval expires 059, 8 <br />F - FAIL F 077 <br />GI SCIfAFGF YC TFIF/Fi°t CAEE11 <br />`~~.~ ,iG L15CEAFCE )~_) tc;. <br />NOTE: Read Instructions before completing this form. <br /> f3 Card 5) <br />0UANTITY OR LOADING Yi10nryJ QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER 3 <br />( ) (54-61) (3945) (46-53) (54-6TJ EX OF TYPE <br />(32-37J AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />rszs3l ~'~-y515 <br />(s4-sal I <br />69-70 <br />SU IDS, TOTAL SAMPLE '`~O~"'" ~'~~'x''`~ nd0i 0 ( I5) ~ <br /> <br />CUSP dNUEJ <br />MEASUREMENT ~ IJ / <br />OU~3U 1 0 0 ~ PEFifv11T- 9~O'~4 OOOCOf ;t;~ O~g~ r"` Q C wCE/ isA~b <br />FFLUY.!iT GROSS YALUE , <br />.FiEQUIREFIENT SC~:1 ~lsk, <br />,~3):IL; 143 . <br />P,o/ [ <br />lCN7t! <br />SULIOS, SETTLEAULE SAMPLE +;.,~;~ww r,.q:)y:r,:q D~04AT/ = ( J~) <br />I <br /> MEASUREMENT ~: ~ <br />L I. <br />L <br /> _ ~ <br />OS4S 1 U 0 ]~ hEp~AII O <br />~ A >Q: i~# O>/y8A j, f ~'~ <br />tFFLUB;dT GHU53 VALUE -13EJ~LYIAC~AENT ~ z;^> _ <br />~ ;~ I/1 ~~~ CstZb <br />liiV~ SAMPLE %:O ,'.=7f: ~'. ~'.}C:: iC~OkY ~.~ F ( IS) <br />~ <br />TUTnL hECOYBHA6LE MEASUREMENT ~• (~ Q~.~ 6 ~ 13J ..~ <br />U:r`JBU 1 U U PERMIT- li0~lli7 TP,C44 # >,~:: ~CAg9 ~. -_, e~~ ~ i. <br />E/ i11'8• <br />k.FFLUE!iT GROSS VALUE 3~1:gi319EF1)"NT te:ao 3Q~~ ~~ - " [16IL . <br />~M18 <br />"IL ANU GHE:AS SAMPLE ``~'^:::~ . .;:~;~r +`.~LL ;;A~dAYC~ ) 5) <br /> MEASUREMENT ~ +~ <br />U3Sb1 1 U U <br />I <br />' -;;., 1T ` <br />~~ <br />~ f+fiO , - a*q~0# xa•^ +Y900>d+0 ~- >a4i~sP~- ~' :~ j „~ <br />° <br />'" -y ~RA-~;- <br />FFLt <br />C~ <br />f GRO55 YALUE dI <br />EC~ L z~;•'~ . <br />;M9~' ~~ jI <br /> SAMPLE <br /> MEASUREMENT <br /> ~'P[;HCv~tY", <br />~ "~ <br /> $~1U~F~ a <br /> SAMPLE <br /> MEASUREMENT <br /> 2~E M x <br />~ <br /> $E <br />NT. i <br />~ m <br />x S <br /> SAMPLE <br /> MEASUREMENT <br /> J°EL$Ullx: , d ~ <br />' y <br /> neNr' <br />~~~l~r 'e ~ L„r . ~ ~~. <br /> > <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM UW THAT 1 HAVE PEflSO <br />ATION SUBMITTED HERE NALLY E%AMINED AND <br />IN <br />AND BASED ON MV TELEPHONE DATE <br /> INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPON ; <br />SIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEV E THE SUBMITTED IN FORMATION IS TRUE, <br /> ACCURATE ANO COMPLETE. I AM AWARE THAT TH ERE ARE SIGNIFICANT <br />l <br /> PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE Ir <br /> POSSIBILITY OF FINE AND IMPRISONMEM. SEE 1a U S C. § 1(pt AND 33 U.S.C. SIGNATURE OF 9 INCIPAL E%ECUTIVE V <br />R utle litres up ro Sro,ooo end or <br />~ <br />m~~ <br />ms ~ <br />na OFFICER OR UTHORIZED AGENT A <br />MO <br />DAY <br />TYPED O <br />PRINTED rmu <br />onmerrt o/OeMee <br />6 mon <br />d5 <br />P rears.l c of NUMBER YEAR <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />T:;S LIyIT DILL He NIIYED ANU SBTTIEAHLE SGLIDS IIfIT APPLIED POH <-IOY5,Z4t7H FHFCIF EYE1~'!; 155 E <br />~~TTLL'AULh SOLIDS 11tIT FAIVBD PON ~lolR,2bre PAE(IF EYEH7 SUEJEei ZC EUHCEN OF E6CCF I1 l.A.i. CIL E <br />S T A <br />EPA Form 3320.1 (OB-95) PraylQus. editions may not be used. ( EpLACES EPA FORM T-40 WHICH MAY NOT eE~3SE6.1 n w ~ -. ~ , an n . - ~ . ~ . e PAGE OF <br />