PEAMITTEE' NAME/ADDRESS (include FanLO~ A'ume/Location i/D~erenrl
<br />NAME
<br />C?I'rt'.i5 YA:1PL YALLF.T COAL CDk.i%.
<br />ADDRESS+ILC3 1, 1~~3 SOUTH, D EC{VAN PF
<br />7LUO i:ASY !1I:IE.rtAL CL,{CLc:
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<br />LOCATION
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<br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.
<br />DISCNARGE MONITORING REPORT (DMR; OMB No. 20417-0004
<br />(z~1s) n7. 91 nAJD' Approval expires OS-31-98
<br />r r~fi r177 .U fi l11. A (~i;nv \Y)
<br />PERMIT NUMBER DISCHARGE NUMBER P - F1 it A L ilJ U T'.
<br />MONITORING PERIOD = )~ r: 1, 1' C ;+ p F T C FO I D E L C R E N R
<br />YEAR MO DAY YEAR MO DAY
<br />FROM VU b U1 TO t%U Ob i0 `x,y'" !i0 DI`_~CRr'.?GF (~( =tom--'%•
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<br /> (3 Card On/y) QUANTITY OR LOADING (4 Cerd Onty) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (48-53) (84-s r) (89.45) (46-53) (8+-sT) EX oP TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />fsz-Gi) ANALYSIS
<br />(6468)
<br />(69.70)
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<br />NAME/TITLE PRINCIPAL E7(ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WRH THE INFORM LAW THAT I HAVE PERSO
<br />ATION SUBMITTED HER NALLY E%AMINED AND
<br />ANO BASED ON MV
<br />EIN TELEPHONE DATE
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<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ,
<br />n ~.
<br />
<br />
<br />Richard MI119
<br />THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION IS TRUE
<br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />INCLUDING THE
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<br />FORMATION ~
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<br />Environmental Manager PENALTIES FOR SUBMITTING FALS
<br />IN
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<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE tB U.S.C.§1001 AND 33 U.S.C.
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<br />tl SIGNATURE OF PRINCIPAL E7(ECUTIVE 97D -S7D-2712 ~/ 7
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<br />§ t3t9. (Parnttins antler These statutes meY inclutle
<br />marimum impnsonmem of behvean6months entl S yetus.l OFFICER OR AUTHORIZED AGENT
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<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerenca all attachments here)
<br />r.L?E'RIIATF LIMIT:. POn 255, IdON 5 SF.TTLEA[iLF s'OLIDS (LOC 'G') APPLY C`NLY IF <= 10-Y F., ZU-Ht; P:iECIP °_vENT
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<br />:•EFA Form 3329-1(0895) Previous editions may not be used ~ ~ v(REPLACE8 EPA FORM T-40 WHICH MAY NOT BE USED.) 00 07 U/ 0 0 0+10 5-15 01 PAGE ~ OF ~
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