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PERMITTEE NAME/ADDRESS pwrLdr FmWryNa./fac.non r/DI)I nnrl
<br />NAME CY .~~lir -• VTL?.°T COAL CODA.
<br />ADDRESS i .i ~ [ :i .. ~ ' I _ _.... r ~ F ~ ~. ,7 1, N ~ {
<br />
<br />
<br />
<br />FACILITY
<br />LOCATION
<br />. I'I'i: "1 O:i T{i° :r•. FY. '~Fti `:P1L nTSY
<br />NATIONAL POLLUTANT DISLHMOE ELIMINATION SYSTEM (NPDESI
<br />DISCHARGE MONTTORING REPORT lOMRJ
<br />lI-161 lI7-791
<br />~JOQ27I;~ n~7 e
<br />PERMIT NUMBER DIBCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAV
<br />FROM I I TO ~ '' 11'1
<br />170-711 lIL131 /74751 176771 LIB-19l !34311
<br />Form Approved.
<br />• .I ° T r ..~ „ o +-.OMe1No~ 2040-0004-. t
<br />(,- I, ~ „ „ ,) Approval ex{~iiec OS-31-98
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<br />. NOTE: Raed Irutruaions befor) eo atinp this Corm.
<br />PARAMETER !3 Grd On/YI QUANTITY OR LOADING /I Grd On1Y1 QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> /46531 1545!1 l3B-451 106531 154-6I1 EX Ky TYPE
<br />l37-371 M
<br />B15
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS !<~.A~I
<br />_ ! r5g7m
<br />:RO!. SAMPLE -'.=k,"-4 ~': $~~kkv:L n:kht`:e t- ( , O)
<br />tJ`iAL Rc.-]p,; {q ai c MEASUREMENT
<br />)I)a4!? L 0 ;) PERMIT r~aarr $n##trF ,; rn#;,~. n ~ ~r.m nPr./
<br />..FFI;U$NT "ROSS 9ALU . REQUIREMENT r:ea,~.p 3QOA AT^ ^AT. Y !!T •^ JV n
<br />~I'1`F:HA POTF.NTIALLT SAMPLE F~R~`.YC #C$R,". 4^:k#-',:.: ( Iq)
<br />T~S:1LYx:D MEASUREMENT
<br />%1?r;u 1 C 1 PERMIT $~m!kd0 00#ffY4 $vk k#001#+p AE PO R'" nFn7a.T t NCE/ ;R'UP
<br />°F'LrJdYY ~R"'SS YAL!!. REQUIREMENT 1kRYk4 30F?A AYS DAIIT !1$ M';/L iON
<br />~,T['?>~:RA POTE3". '. I,?.Y SAMPLE tor•k4S-k^• t:~l: G$~ S:J,a;h:}$^ ( IO)
<br />il: :.OLY6D MEASUREMENT
<br />.1]-~i1 fl 1 0~ 0 PERMIT •.~#i. "L C4
<br />A 1`.47Y rt~ 4~Xt ::k itat ~-^ f.1.!77l r.':' Ij !7Fy/ ;DAn
<br />:;FLUENT GR955 vgLl!r REQUIREMENT :~;ktk Tnng Av^ DATT.Y P!y MG/[, gOVTH
<br />'.i':';AN ES E• TJTAL SAMPLE +-~?:$ #'k ;tfi ..': $:".t^'..`- ( 17T
<br />..:C:7YEHAdLF MEASUREMENT
<br />:.113 I D Q PERMIT .'.': -".i=+=#i:t ~v::tn,$fi #$k }Y,ta$r::;: A'; n^D.i. u^rnV^ F
<br />'yL° ;?~A
<br />.?°L11°NT GRJ55 V!!L'i:' REnuIRENIENT $03~ 3~D3 AV^ 7~ILT >~E ".t=/I. .
<br />'l.C7A IN CJNDOT" D^ SAMPLE ( ]3) =$r:ar.- ,-...t>!:h~. .e;:~:,k:~
<br />~: 'r'. ~:: THSATME9T -'L6"" MEASUREMENT
<br />31](!`jL 1 0 .^ PERMIT F, F.P JRT 1?rpJRT kt:$IR~sfA ..~~##'$ ..-;;:r'x ,. r.;:~
<br />rF'nLiJEnT ;P'1'- vAllil REQUIREMENT ]ODA AYCy DAILT "!Y !11:Q tt:~v"
<br />AIL AND ;P°^.' SAMPLE #CxGh; ( ~0) #tt:r».^:~: $$%FC#s +-Ar<..,,:,,
<br />_T S ~ ~ L MEASUREMENT
<br />.. 'AUbI) I J J PERMIT C~3 D#P T F: i=I k'#?$$f,: #., #!/;bY= :71~•~;;-'::;r $..:t t•?y,Lv T~ti fill.
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<br />° i•' L J E ;' i' G 3 ;1 ; d 4 L"° REQUIREMENT T N ~ T .q A '{ Y'1= D # ::~ `
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF L
<br />MILIM WITH THE INFO AW THAT I HAVE PERSONALLY E%AMINEO MD
<br />RMATON SUBMITTED HEREIN; MD BASED ON TELEPHONE DATE
<br /> MY INOUIIIY OF TNOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
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<br />d M(II OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
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<br />S TRUE, ACCUMTE AND COM0.ETE. I AM AWME THAT THERE ME
<br /> SIONIFICIWT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING f
<br />=nvlronmental fYtanager ,
<br />THEroS51BILITYOFRNEANDIMPNSONMENT
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<br />11001MD3 970 A70-2712 10 1.3 96
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<br />3 BIONATURE OF PIIINgPAL E%ECUTNE
<br /> U.S.C. E 131x. lPrWei. unM 1Mer mfuna nrY YcpnlA rm., w ro ! fO,OOD AREA
<br />TYPED OR PRINTED Ana ermuNxnr Ynpvlawrwlr el MrwwnemonlAAendSYAraI OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV
<br />COMMON l i AND CAPL.RNA111 V N Vt qN T V I V LN I I V NJ 7rterereDCe e/! BRICD/neDrc natal
<br />I,';i:RNATE !.I"I" ~Y7° .: ; ,3I"'
<br />--.r.INED. .`:~~ 7.A.?, ''-' I.:r F'lu LF43Lc 'PLC^S (LO.^. E„1 3D?T.Y Il`'L° T°
<br />41JR0f'": OF PRO3r avnlLaFaiv..._. ^T7. F, <- I^-'r°, 711-c'q n._..-r•Tn
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<br />EPA Form 3320-1 108-85) Previous editions may be used. IREPLACE6 EPA FORM T40 WHICH MAY NOT BE USED.1 ^ ~ T r rl / 0 ~ n„ ^ ~ _ T .) Z n PAGE T OF
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