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PERMITTEE NAME/ADDRES$ nndude FacilyName/Cocarion fDgerenr)
<br />~r^ NAME sErECA COAL CCl FANY
<br />ADORESSp g -~M $ r D .~
<br />NAYDBr CO 81639
<br />FACILITY - ^~n°:~~ '
<br />Locnrlor~AY08w ~ '' ~', , ` 630 YE,9T
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<br />DISCHARGE ELIMINATION SYSTEM (NPDES)
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<br />Form Approvetl. ~~,
<br />B I N G E OMB No. 2040-0004 ~Y
<br />(5 U B N I! Y) Approval expires OS-31-90~ .#
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<br />LISCBALIGE TC GEtSSL CLEEN
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<br />NOTE: Read Instructions before completing this form.
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<br />NAME/TITLE PRINCIPAL EJ(ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO
<br />AM FAMILIAR WITH THE INFORMATION SUBMnTEO HER NALLY E%AMINED AND
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<br />AND BASEb ON MY ~ TELEPHONE DATE
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<br />' INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS TRUE, / '
<br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING THE
<br />POSSIBILITY OF FINE AND IMPRISONMENT SEE 1a U.S.C. § 10D1 AND 33 U.S.C. IGNATURE OF PRINCJ AL E%ECUTIVE
<br />§ 1319. IPenettie5 under !hate SlerNes may include lures up ro 576,000 end w
<br />TYPED OR PRINTED merimum impnsonmenl of be7ween 6nronths end5yeers) OFFICER OR ALIT RIZED AGENT A
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<br />NUMBER
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) 7
<br />TS5 E IRON LiEITS ~LLI BE wAIYBD 8 58TTLLaIBLE SCILLS LIf!IT AFFLIEC FCF C=10Y8,24E! FlECIE EIl6~L 7I5,
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