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PFRM]ITiEE NAME/(10pRE55 l5rL4. F.r41ryNw/Loca4an dD~9
<br />NAREE POYD~AMORN COAL COMPANY
<br />ADDRESS ttOADSI DE MIu;;, N ~ 3 L~r_~HT.A LJ
<br />P.U. 5oi lui0
<br />PALI~AUE
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<br />CO~O~SUCH~/ILL6 ($URH fiC) PProva ~PItp8.0 - -98
<br />PERMIT NUMBER DISCNAnDE NUMBER P- F I A A L
<br />CO H1~25 KINOR
<br />FACILITY MONITORING P 0
<br />LOCATION
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<br />YEAR MO DAV YEAR MO DAV _
<br />FROM Y t; TO .'## NO CISCHARGE )__~ #^-#
<br />It6tll It7-731 !1475/ lt6t7l IIB-79I !363/1 NOTE: Reed Inetruetlpq belora completlnp this form.
<br />PARAMETER 13 Grd Onlrl QUANTFFY OR LOADING !I Grd OnIY! QUANTITY OR CONCENTRATION NO FREOUFHCY SAMPLE
<br /> !4653 !546/1 138-451 !4653 151-61/ DF
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<br />NAME/TFFLE PRINCIPAL EXECUTNE OFFlCER I cwn Fr UNDER PENALrr oP uw THAT I NAVE PERSONALLY ExAMiNED AND TELEPHONE DATE
<br /> AM FA MILIAR WITH THE INFORMATION SUBM4TED HEREIN; AND BASED ON
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<br />J MY INDUIRY OF THOSE INDIVIOUILLS IMMEDIATELY RESPONSIBLE FOR
<br />OBTNNING THE INFORMATION
<br />I BELIEVE THE SUBMITTED INFORMATON IS
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<br />A TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE APE
<br />SIGNIRCANT PENAlTlE3 FOR SUBMITTING FILLSE INFORMATION, INCLUDING
<br />9~o Z~-4i'o/
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<br />p ~ THE POSSIBILITY OF FNE AND IMPRISONMENT. SEE 15 U.S.C. 1 1001 AND 75
<br />' / 610NATURE OF PRINCIPAL EXECUTNE
<br />
<br />TYPED OA PRINTED U.S.C. 1 1 JI B. l/MW14r u,d•- e
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<br />OFFICER OR AUTNORRED AOENf
<br />CODE
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRelerence ell attachments halal
<br />'PHIS OUTFACE IS NOT BLLGIRLC FOH E7C2MPTIONS PP.OM TOT Al SJSP°NCPC SCLICS (T5S), 7CTAL IHCV ADD/03
<br />~N,TTLEAt3Lc SOLIDS LIMLTATIOtiS - SEE I.A.2.
<br />EPA Farm 3320.1 108-951 Previous aditiane may be used. IREPLACEB EPA FORM T40 WHICH MAY NOT BE USED.1 0 0 3 3 3 / 9 9 C 2 2 3 -12 5 6 PAGE 1 OF
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