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PERMITTEE NAME/ADDRESS (include Famliry Name/Gecation ijDifferentl <br />NAME CGLQMCU COAL i:GPFA':Y, L. p. <br />ADDRESSCC LOrYO AINE <br />S/jl STATx` RIGHYAY IJ <br />FACILITY A F. E!t c R L O y l f, 4 <br />LOCATION <br />AT'fN: J• u. NAP.tlt7N. /:z.`.'='(A[ .MANaf.Fi? <br />NATIONAL POLLUTANT DISCHARGE EDMINATION <br />. • DISCHARGE MONITORING REPORT <br />u 12-J5) <br />.r ._: <br />?" *~ ~ PERMIT,,NUMBER °'~~ oisi <br />~. , . <br />i (NPDESI Form Approved. <br />tl , j / 7 i OMB No. 2040-0004 <br />Approval expires OS-37-98 <br />~+ (BURR NM) <br />NUMBER e _ PL~IAL ~ ~ ~ P.ceA? <br />aA588AT ?b YORK ARC';, FOH?; <br />DAY ,~. ' __ <br />/ao~sn ~~%.'3tSN9Ti ~: Read Instructions before completing this form. <br /> (3 Certl Only) QUANTITY OR LO/iU1NG (4 Oard Ony) QUANTITY OR CON <br />T <br />ION <br />CE <br />A <br />NyTyR NO. FBEOUENC SAMPLE <br />PARAMETER (4653) (54-6/) ~ <br />~ <br />~, <br />.,, <br />~ <br />(38-45) (46-53) "~(5Z'-81) .. ~ EX OF TYPE <br />(32-37) AVERAGE MAXIMUM ~ NITS MINIMUM.'. AVERAGE M~IMUM UNITS ~ ANALYSIS <br />'~OLIUS, T(JTAL SAMPLE ":41fQ•l"[ ':=fJ##Ye# a#r4a•o 291' <br />! <br />S U S P °:0 i k; !! MEASUREMENT +Qj 1 S . <br />~.iy;~,; ~ 1 G <br />ra <br />Gj <br />U+)J1J 1 V U PERMIT ., RF+@t~iFaR~R'i _•?! `~ <br />' " fifs¢ ~ ~ `~ ~'` f~ ~Y ~~ V,:t s~ . <br />~~ <br />~~ <br />k~R~~~. <br />TFFLUEtiT GRUBS YA~Ur -REQUIREMENT I• <br />k <br />• <br />I~1/N SAMPLE :.~;;.. .i rrt ~eY1! ,.; , i•dQI~CG.^:g11 ~ I9) <br /> <br />TO f a L `• EC^_ Y r: P A° L P <br />MEASUREMENT <br /> <br />~ <br />O I °I <br />O (`~ ' <br />Gral <br />UU) tlI 1 U U `. PERMIT - ~7AP>'f0•P ~ ~'`O# h#C~ ,.~'.'~z,'?l ~ "~(J <br />~~ ,+~ <br />• <br />PFF'LU?s '•T :ROSS VALUi• REQUIREMENT ~ <br /> <br />.., ,~~.~'+, <br /> <br />~ ~ :}#~: ;t ~°- , <br />6~~2~"T t1~. ,. <br />W L ~~ ~' <br />, <br />^~z,. <br />F LO';, [:: CONDUIT (;fl SAMPLE ( ^l) #1R Ipl4tta b##;tn-: rtrt4#.~4 <br />1't!t?U T'rP.ATf"ENT FLANi MEASUREMENT n~a. ''`~a <br />~~ <br />SUUSIl 1 U U •.:•PERMIT. , A&P4?>i!t :~$AFQ1T';` :. +. .. tµ i)Pyji7y~'d #t:p ~ <br />' .. <br />~ <br />°f'FLUx"~'T GNU:;S YALGF REGUIREMENT ~Q`Jb''lC#G`~' 'bAI <br />3 <br />~°JI' 'tGL "" ~ ~~'" <br />>" r" <br />'~` ~ " <br /> 2 <br />• <br />- : ~., ^ <br /> SAMPLE _ <br />my ~ , <br />~ ~' <br />~ <br />~ <br /> MEASUREMENT . ~,: . <br /> 'PERIVI7T' - - <br />• <br />' <br />~ -~ T 7 ~ <br />~. <br /> 7REOUIREMENT " <br />~ .-.: ' ~ -: <br />-_ <br />,. ie`:. -n •, }I <br />"~, a ~'' :~~~~ ~ .. n~° . j. <br /> SAMPLE <br /> MEASUREMENT <br /> ~PERMITe. -~ <br />~ ix a. - . <br />~ ~~ q- ; - i <br />2 <br />e 1 <br />~~ !. x ~~~: <br /> REOUIREMENT <br />~ ~ `~-'~ ~~ ~t ='' ~ <br />1 <br />x <br /> i t,.,.-, a b•+ <br /> SAMPLE <br /> MEASUREMENT ' <br /> 'PERMIT, :. ` "e .+ <br />~ ,. .."" ~' ~i, <br />~ ,-• ~~ <br />` ~: <br /> <br />REQUIREMENT, _ <br />RR <br />: ,},, <br />r~ <br />i <br />. <br />* <br />~' . <br />f z <br /> <br />. ,~ _ _ . :~ <br />., . <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMIT ~: 3 S r <br /> <br />C <br />2 -."~ : ~) .;" <br /> <br />~ <br />u y zmxR•*+e <br /> <br />-*tr <br /> <br />mo' ~~ ~ ('. <br />, <br /> REQUIREMENT, t <br />~ - ~ <br />' <br />~ <br />~-~~ r <br />~ ' <br />t ~ r <br />m t <br /> _v ~ <br />.. , <br />.4ri.F <br />~ <br />4. <br />, <br />+ r . <br />. s, <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR W <br />TH THE INFO <br />M LAW THAT 1 HAVE PERSO <br />AT <br />O <br />SU <br />ER NALLY EXAMINED AND <br />E TELEPHONE DATE <br /> I <br />R <br />I <br />N <br />BMITTED H <br />E <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON <br />THE INFORMATION, I BELIEVE THE SUBMITTED IN IN: AND BAS <br />D ON MY <br />SIBLE FOR OBTAINING <br />FORMATION IS TRUE. <br /> <br />~~ <br />/ <br />~ <br /> <br />~ ACCURATE AND COMPLETE. I AM AWARE THAT TH <br />PENALTIES FOR SUBMITT <br />G FA <br />SE <br />MATI ERE ARE SIGNIFICANT <br />DI ~ <br />1, ~( <br />' <br />,~( ~ • ~ ~ y IN <br />L <br />INFOR <br />ON, INCLU <br />NG THE <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. § 1001 AND 33 U.S.C.; SIGNATUIjE OF PRINCIPAL E7ECUTIVE • 17/ 1 R~ - ~l./J /' /`~i. ! '•( ~ <br />, _ <br />TYPED OR PRINTED § 1319. (Penalties untler these slelules may include lines up ro 510.000 antl br.: <br />maximum tmpnsonment of helween6momhs entl5yesrs.) . OFFICER OR AUTHORIZED AGENT <br />r A <br />E <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments here) ";;;; q; , V <br />':1)':ITD`nZN;, RVQUIREY.EtiT.'.• S':'E I.!?.l.i`, PG. S. PUADYN QF PR~`R°QUIRLrE.NTS - SES I.A.2, PG. L. <br />`,' <br />0-1.(08?95); Previous editions may not be used (REPLACES EPA,F.ORM T 40 WHICH MAY NOTBE USED.) .~P,AGE OF <br />• <br />... , <br />,p43.Tl~b, U~ti1: ~ .. <br />a,~,~.,~,a. , <br />