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PERMITTEE NAME/ADDRESSp r6 FacWryNar/Loem:m VD:dnu) <br />NAME SGNGCA COAL COi'PAtiY <br />ADDRESS DkArER D <br />NAYDEM <br />CO 81639 <br />FACarn <br />LOCAr1DNHAYC~N CO 81030 <br />ATT1+: G. BUD EkOkV, GttiEisAL !!ANAGER <br />NATIONAL POLLUrMT DISCNMGE ELIMINATON SYSTEM /NPDES) <br />DISCHARGE MONITORING REPORT fOMRI <br />1-761 I7-191 <br />COUOOD2z1 Clt W <br />PERMIT NUMBER DISCRMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM ~ O Ul TO y ~ . 1 <br />/1477/ /12-13/- /7i~15/ lI617/ !IB-79! /3637/ <br />Fonn Approved. ~ <br />1CCT~ it ::T CtS:IE:GOMB)No~20400004 4 <br />r n Approval ezpirae~05-31-98, <br />F - FIhAI <br />"INCF ° <br />NOTE:,. Reed inetruetlora before eompletinp this form. <br />PARAMETER !3 Grd ONYI QUANTITY OR LOADING ~ !I Grd OnlYl QUANTITY OR CONCENTRATION NO, FREDUENCr SAMPLE <br /> !<s531 !54671 I3B<51 !46531 1545/ <br />EX OF <br />YSI <br />TYPE <br />l33-371 AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rsatsi MAL <br />S <br />!54591 169-701 <br />LL"UU SL'AL'tl 4tl. :f All SAMPLE •~`'~•'p .`,e Ce} ar'F%5"} ~ <br />~ ~ V t?t:?~'~ •„^• ° ( ~j) <br />(/ / <br />I <br />~ <br />C'E:kI00AYilNIA MEASUREMENT V ~ <br />TAn3B 1 0 0 PERMIT r=~}~:s~,s.. . ::.sx~+.aT .~:} 100 ~ar~a:s :}rt>r~,:t, IEp., ? rTRLZ ;HAS <br />EFFLUENT i;k055 VALUE RP.nuIREMENT : fro lit: pALk-E. CENT <br /> SAMPLE <br /> MEASUREMENT <br /> .PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ~ ~~ . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ~ ~ ~ ~~ ~ ~ ~ ~ . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. ~ ~ ~ ~ ~~ <br />° <br /> REQUIREMENT ~I. ~. <br />. ~ ~. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />-•--- <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cERn Fr uNDI:R PENALTr of LwW TNAr l NAVE PERSONULV ExAMI NED MD TELEPHONE DATE <br /> <br />1 <br />qA K ~ 5 yl: °n ~~ AM FAMIUM N/ITH THE INFORMATION SUBMITTED HEREIN; MD BASED: ON <br />MY INQUIRY OF THOSE INDIVIpUN.S IMMEDIATELY RESPON4eLE FOR <br />OBTNNING THE INFORMADON, 1 BELIEVE THE SUBMITTED INFORMATION Is <br /> <br />~ <br />/~ <br />I ( TRUE, ACCURATE MD COM0.ETE. I AM AWME THAT THERE "ME <br />NIFILMT PFNN <br />SE INFORMATION <br />9 <br />n ES FOR SUBMITTING FA <br />INC <br />UDING ~ <br />~ ~ ~ t i <br />1C/ <br />'/ <br />I <br />r <br />~ <br />/ 1 ~ ^ <br />~ 1/~ J ~ J ~ ~ Cl ~ <br />r`i V ~J . <br />, <br />G <br />L <br />L <br />THE POSSIBILITY OF RNE MD IMPnI50NMENT. SEE 18 U.s.C. f'~tC01 MD 37 i <br />1 V ~S <br />• <br />1 `~ I <br />lJ U <br /> u.s.L. 1 t Ste. 7/+N°AU.• Mlwr eww mnmF mFr ItcA.e. rwF w m ! Io,ODD 610NATURE OF PRINCIPAL EXECUiNE AREA A <br /> <br />TYPED ~R PRINTED <br />Wor ntuvnun irericnmvn a/MrrwnemendM rN eYwa/ li <br />OFFlCER ORA ORIZED AOEN7 <br />CODE NUMBER YE <br />R MO DA <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRe/eience s/l sttechmenb here) <br />5K8 PAkT I.A.4 FCR CF.T:IIL3 OF TEST PkOCED'JP.E. REPCHT LUI~EST CIIUlICN (R EFFLU£!T) ~F!ICY. IS LETHAL TG 50". <br />UP TEST ukGAVI5M5 (LC50) AhD ATTACH ACOTE TOXIPIY TEST REPOFI £CP! 7C Cr9. CCF]ES OF aLL .INFG@CtATICN <br />MUS'P RF SMNT Tn FPS <br />EPA Form 3320-1 108.951 Previous editions may be used. (REPLACES EPA FORM Td0 WHICH MAY NOT BE USEO.1 <br />0013.%471031-1513 PAGE OF <br />1 <br /> <br /> <br />