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PERMITTEE NAME/ADDRESS Qndade Faciliry NameJLocatmn JDi$ercnp
<br />NAME CULr?~IYJ COAL CO:'.PA7Y, L.:.
<br />ADDRESSCOLOVTO MINP_
<br />1'!31 SfATF. flIGRVAT'I3
<br />FACILITY H6EKf:H CT) 91b.1,-~'•,~
<br />LOCATION
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<br />~' 'FROM
<br />Form Approved.
<br />OMB No. 2040-0004
<br />".I!~ C A Approval expves 05-31-98
<br />F - FINAL NOFIT'
<br />CULCtt A SGDI POND/COOT 5PG5 CR
<br />~~NOTE: Read Instructions before completing this form.
<br /> (3 Cerd Onry) QUANTITY OR LOADING ~ (4rCerd Onty) QUANTITY OR CONCENTRATION NO. FAEOUENC SAMPLE
<br />PARAMETER (4653) (54-61) (3a-05) (46-53) (54-67) EX OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNI: MINIMUM. ~ AVERAGE MAXIMUM UNITS
<br />(s2~ss) ANALYSIS
<br />(64-68)
<br />69-70)
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSONALLY ExAMINEO AND
<br />ATION SUBMITTED HEREIN
<br />AND BASED ON MY t'~ TELEPHONE~'~']
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<br />r 'DATE
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<br />INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ///
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<br /> THE INFORMATION, I 6EUEVE THE SUBMITTED INFORMATION IS TRUE; ~
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<br />~ ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT I
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<br />r. t.. PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING THE
<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE IB U S.C. § 1 Wt AND 33 U.S.C.
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<br />SIGNATURE OF PRINCIPAL EXECUTIVE .~ ~ h.a~
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<br />TYPED OR PRINTED 4 13te. IPenePo
<br />es under these s2tutes may inclutle liner up to EtO,ooo and a
<br />maximum rmpnsonmenf of beMSen6mpnths end5years.), OFFICER OR AUTHORIZED AGENT ' 'A
<br />,/ ________ .:GOOEY
<br />'NUMBER
<br />YEAR
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<br />DAY
<br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS (Relerence ell attachments here) - °~ I ~ ~-r°._ "~'~
<br />5?TTLEABLE SOLIDS LI!IT APPLIES ONLY IF C=1OTR,24HR FRECIP EDEN? IS CLAIMED. I ~ tM APPROVED Ri V~,CU,
<br />TSS G IRON LIEITS MILL NUT dE APPLI°D TO.RF.FORTED~-'F.ASURECEMTS - SE£ I_A•ZR'.4G__ A_EURDEN OF PRCOF
<br />.EPA Form 33247 (OB-95) -.Previous edaloris may not be used ~ ~,. (REP'LAQES EPA FORM T-40 WHICH MAY NOT BE USED )~` ` ~ ~ ~ ~t~~ ~ ^ "`~~ ~~f ~ ~ PAGE ti OF
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR;
<br />(2a B1 (1]~ 9)
<br />r'f1ROi'S1 F.t nAd_1-.'
<br />,;,-PERMIT NUMBER DISCHARGE NUMBER
<br />'~ ! MONI TORINGPERIOD~
<br />YEAR MO DA
<br />t 0 DY Yi Y,~~ ~ '~" gYEAR MO DAY
<br />d r0 OD 06 3U
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