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PERMITTEE NAME/ADDRESS pnclude Facilirc Name/Lncariun fDi$eren0
<br />NAME
<br />CY~FU~ YA+SPA~YALLEY COAL CG3F•
<br />ADDRESS1LNt:U 1,16.) SOUTH, t: F,CKCA9 F'%(
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MRDESJ
<br />DISCHARGE MONITORING REPORT (OMR~
<br />(~-16) (1 ]- 91
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM U U U b 71 TO O C 0 ti j 7
<br />(2P21) (22-231 (2d-251 (26-271 (7a-zaf (30-311
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<br />. ~, •~ • I.1_~.
<br />Form Approved. ~~11~~
<br />OMB No. 2040-00®4 '
<br />h A J 0 6 Approval expires 05-31-96
<br />(sUIiR 'l ll)
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<br /> (3 Certl Only) QUANTITY OR LOADING l4 Card Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46-53) (54.61) (38-45) (46-53) (54.61) ~ EX Of TYPE
<br />(32-37) AVERAGE MA%IMUM UNITS MINIMUM AVERAGE - MAXIMU UNITS
<br />(6x631 ANALYSIS
<br />(6468)
<br />69-70
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<br />NAME/TITLE PRINCIPAL E%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; AND BASED ON MV TELEPHONE DATE
<br />
<br />Richard Mills INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION, I BELIEV S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE SUBMITTED INFORMATION IS TRUE. '
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<br />i ACCURATE AND COMPLETE.
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<br />BMITTIN I AM AWARE THAT THERE ARE SIGNIFICANT
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<br />970-870-2712
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<br /> POSSIBILRV OF FINE AND IMPRISONMENT. SEE 1B U.S.C 4 1001 AND 33 U.S.C.
<br />000 antl or
<br />roSf0 SIGNATURE OF PRINCIPAL E%ECUTIVE
<br />TYPED OR PRINTED .
<br />mer~'muniPmpnsonmBnr or batwee re6 monlhsyentl5yasrs)sup OFFICER OR AUTHORIZED AGENT
<br />NUMBER
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS'(Ae/erence ell attachments here)
<br />DdTE;t"iIh° jU-DAY AYEh9r:S r'JiCENTFAPTJ^ dSI'~G A ':Oe+'AL +:EITN"rIIC :'~~P.L OF 6LL -~'sLi :E~,LI'S _bTkINi•D Fi:GP
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<br />(08-95) Previous editions may not be usetl. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) PAGE OF
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