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PERMITTEE NAME/ADDRESS (lndude Focdire N'ame/Locarion iJDifferenq
<br />NAME CnLOY)0 COAL COMPANY, L. P.
<br />ADDRESSCO LO:I T O M I 5 E ..
<br />5731 STATE HIGFIYAY 13
<br />FACILITY hF. F;KrR CO elb4l
<br />LOCATION
<br />A"ITN: J. L'• !tARI!ih, f.FNP"iAL MAVAGFP
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR~
<br />IS t61 p]- 9)
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<br />PERMIT NUMBER ~~= rliiSCHARGI'NUMeER
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<br />MONITORING PERIOD
<br />YEARi
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<br />:;51q DAYS IIY,EAR
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<br />Form Approved.
<br />OMB No. 2040-0004
<br />'~•L !' ~~ ° Approval expires OS-3!-98
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<br />F - FIRAJ, !{OPAT
<br />I~IMIMG;QIT TO P90SEPCT POND
<br />NOTead Instructions befor completing this form.
<br /> (3 Gerd Ony) QUANTITY OR LOADING .(4'Ger"tl Onry) QUANTITY OR CONCENTRATION -NO. FREOUENC SAMPLE
<br />PARAMETER (46-53) (54-61) °y„J (38-05)- (46-53) (54-67) 'E7( OF TYPE
<br />(32-37)
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<br />(sz-uYr ANALYSIS
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<br />69-70
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<br />NAME/TITLE PRINCIPAL El(ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WRH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HER NALLY ExAMINED AND
<br />EIN
<br />AND BASED ON MY /I
<br />~` TELEPHONE DATE '
<br />
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON
<br />THE INFORMATION, I BELIEVE THE SUBMITTED IN ;
<br />SIBLE FOR OBTAINING
<br />FORMATION IS TRUE, //
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<br />ACCURATE AND COMPLETE. I AM AWARE THAT TH
<br />PENALTIES FOR S
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<br />ERE ARE SIGNIFICANT '
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<br />INFORMATION, INCLUDING THE
<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE to U.S.C. 4 1001 AND 33 U.S C
<br />SIGNATURE OF PRINCIPAL E%ECUTIVE rr~~
<br />9171
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<br />TYPED OR PRINTED § t316. (Penettias untler Ihese srewras may inclutle lines up Io 310,000 end?ord.
<br />maximum lmpnsonmeM Ol OehveenBmonths entl5years.) OFFICER OR AUTHORIZED AGENT
<br />~, AR
<br />
<br />CODE
<br />NUMBER'< ~.
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) w...: -'~2'.Y"
<br />°!;NLTOGIwG d:ivL'IRF~LbTS SF, F. I.9.1.Pr FC. 5. L~U?D FN OF PROOP RL(jUTAEMFNTS - SEE I. PG. 4.
<br />EPA Form 3320-1 (08A5) Previous editions may not be used. ,
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