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PERMITTEE NAME/ADDRESS (/nclude Faulirv Name/Lrrcanan ijOr$ereny <br />NAME ~... NATIONAL POLLI <br />SLh£CA COAL ~CEFIMY DISCH <br />ADDRESSp H A Y£ k D <br />CI-C000C <br />kA`lDtp CG 91£J9 ~, ~~'. PERMIT <br />FACILITY ~Gr_U~7_Q~ ~} <br />LOCATION A Y 0811 L I. d I E 30 „~//,~`i <br />a'ITIi: G. bUC r!tt:'>i:l~ ChNEItAL hihnGEfl <br />to TEM (NPDES) Form Approved. <br />R;9) „) ry G h OMB No. 2040-00~. <br />Approval expires 05- 8. ~ Y <br />~ a ~:,udk h-) <br />DISCHARGE NUMBER ~. - E I ! A I I FG UZ <br />IOD LI~CNASCE TC 6fi19S1 CBEER <br />.R MO DAY ~ .t __ <br />vl rze-zsl r.TO au NOTEi. d Instructions befoh. comDletinD this form. <br />PARAMETER (3 Cartl Only) QUANTITY OR LOADING Cartl Onty) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br /> (46-53) (54-67) (38-45) (a6-53) (54-6 ]) EX OF TYPE <br />(32-37) <br />•.~~y~ <br />AVERAGE <br /> <br />~ <br />MAXIMUM <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br /> <br />(fiz.63) ANALYSIS <br /> <br />(6466) <br /> <br />69-70 <br />' <br />( Y <br />~ <br />. SAMPL4j :`~: ~' 1 ) Ye4 C-AC JvSL4 <br />~ <br />HtiU T.'.EATEEYT PLAAI MEASUREMEN ~~ O <br />Z~ D ~ 1K <br />C ~ <br />5 <br />G511 1 0 1 PERMIT " Q ~ , ,c baa ~ <br />F.FFLUE~~'I (,rt03$ YALUL ` <br />Q!)I~iEMENT _ <br />~~(~~; 3v'~~ FCr -~ ~ ~~ , CL;{ ~~ <br /> . ~ r ~ <br /> SAMPLE ~. <br />, '` ~'~ <br />' MEASUREMENT '" <br /> <br /> <br /> <br /> &LE <br />~ <br /> MEASUREMENT ~ ~ ~ 1 <br /> PERMIT` '~_. .,~• ~,- -, <br />-"~ <br />" <br />~ <br />` <br /> ~AEQUIREMENT - .., ]~ r nl~=I <br />, <br /> SAMPLE <br /> MEASU <br />ENT <br />R <br />E <br />M <br /> .. {"~ <br />(~ <br />~ <br />~ <br />+ <br />- `~ - <br />~ <br />1 q <br /> ~~Nx .5a- <br />~ + ~: 1 <br /> a t 1 ,../::: <br /> SAMPLE <br /> MEASUREMENT <br /> f'CpMIT ' <br />~~~e <br />}DIREML~FiT <br />t <br />-~: <br />' ~~.~ <br />~ <br />~~~ m. '. <br /> : ,,~ r <br />,r~ z <br />s,.,, <br />-. <br /> SAMPLE <br /> MEASUREMENT <br /> ~~'" <br /> RE4UIf3EMENT '., ' <br /> ~ <br /> SAMPLE <br /> MEASUREMENT <br /> .. PE~Mkf .~ ~ ~' <br /> <br />NAME?ITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF L <br />AM FAMILIAR WITH THE INFORM AW THAT I HAVE PERSO <br />ATI <br />ED H NALLY E)(AMINED AND TELEPHONE DATE <br /> <br />INQUIRY OF THOSE INDIVIDUAL ON SUBMITT <br />EREIN. AND BASED ON MV <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE. <br /> ACCURATE AND COMPLETE. <br />PENALTIES FOR SU6MITTING I AM AWARE THAT THERE ARE SIGNIFICANT <br />FALSE INFORMATION <br />INCLUDING THE <br /> <br />POSSIBILITY OF FINE AND IMPRI , <br />SONMEM. SEE 16 U.S.C. § 1001 ANO 03 U.S.C. <br />SIGNATURE OF P INCIPAL EXECUTIYE v <br /> g t31S. IPanamas untler +hase s latutea may inclutla lines up to Er0,000 antl or <br /> <br />TYPED OR PRINTEp <br />maximum impdsonmenl of Eerwsan <br />bmonl/u antl5 years.) OFFICER OR HORIZED AGENT <br />NUMBER <br />R <br />MO <br />DA <br />V VNIMtN I J ANU txYLANA I ION Uh ANY VIOLATIONS (RB/BBnCe al/ atlaOhmBnIS he/9) <br />TSS b LNOk LI;fITS VIII tiE MAiYEO E BBTiLEA91E SCLICS LICI': AFFIIEC FCB <=LUYk,iuFh FFECIF EYlR~; 495, <br />IkGN E: SETTLkAbLE SCL]CS LIMITS YIIT~D FOH ~lOYp~:YfiF PkEC1F EVE117 SUE,]EC1 TO HGFLEF CF FFCCE IR I.A.Q. <br />s? r ~ ): r a a ~ c v_ S E-E' i F ~ c acs r n u L?Laii.L+A'' * .-9-a I$ <br />EPA Form 3320.1 (OB-95) Previous editions may not be used. ,~,,.~y(IiEPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) n n nn a i oo r a ~ a _ + a e n .. PAGE . OF <br />