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PERMITTEE NAME/ADDRESS pnclude Foailiry NamdGooarion jDiBerenq NATIONAL POLLUTANT DISCI <br />NAME DISCHARGE MO4 <br />S2MidCA COAL CCL EANI ~rza61 <br />ADDRESSDRAYfiR D_Lfl_0_DI DS_~21 <br />NAtDEN CO 81639 ~ PERMIT NUMBER <br />FACILJTY MONI <br />LOCATIO YEA ~ MO DA <br />LJIAtDEN CO 81630 FROM '' <br />ATTM: G. kiUD 6BOYN~ GEMf hAL RANAGFB lZo-z1J !zz-271 (24.2 <br />ELIMINATION SYSTEM (NPDES) <br />NG REPORT (OMR; <br />Ql- 91 <br />' DISCHARGE NUMBER <br />lsoarl <br />. Fxm Approved. <br />r I ,~ a ti oMB No. 2oao-oooa <br />A¢proval expires OS-31.9 ~' <br />~suea. Nr~ <br />F - PIIIIt <br />elstMiDit ~FC ciA.sst CHtfN <br />L4• ":~~.~tlnCl,tli[" ~~.r~ ( ono <br />N'ead Instructions bef6re completing this form. <br /> (3 Certl OnryJ QUANTITY OR LOADING (4 Card Only) QUANTITY OR CONCENTRATION `~t. Oi <br />~ FREOUENC SAMPLE <br />PARAMETER (46-53) (54-67) (3a-45) (46-53) (54-61) ~. ,~ <br />X OF TYPE <br />(32-37J AVERAGE MAXIMUM UNITS MINIMUIyY AVERAGE MAXIMUM U)513'S ~ /62&71 A(64LfiBJS 69-70 <br />ZL ANU GREASE <br />V <br />UA SAMPLE <br />MEAS <br />M <br />N >ROCQ ~ <br />~ ~ V) ~~~ <br />~ r.A~Y+.~O ~~='C4 <br />~ <br />~ <br />I/3 <br />S <br />U <br />tS <br />L URE <br />T <br />E I <br />84066 1 0 1 ~.~~~ ~" ~x~ "~' `'~~ .~ Fc-1 I :_- ~ >D0i ~~ <br />. <br />~ ~' <br />' <br />EFFLUENT GBO55 YALUE NI~`E1T <br />1 <br />~~ a'~ 'j~~~~~~ lC=G <i`"' n'~. <br />- s~cys + <br />~ <br />, -~~*8 : <br />~-. <br /> - <br />, <br />± a: k _ y <br />, <br /> SAMPLE <br /> MEASUREMENT <br /> • <br /> V1 ) ~t4~Fl <br />~ ` ~ {'- <br />T M t . <br />.I <br />~" ~fr ~,, y*': <br /> ~ <br />• YT ~S Y <br /> SAMPLE - <br /> MEASUREMENT <br /> <br /> <br /> SAMPLE <br /> MEASUREMENT <br />. - - ' <br />' is ' t' ` ~ <br />`-~ . <br /> ~ * ) "< ~ <br />' - <br />~ <br />~` <br /> SAMPLE <br /> MEASUREMENT <br /> x <br /> d V i} ~ C Y G <br /> saMPLE <br /> MEASUREMENT " <br /> i ' yh i4 ' ~,~ IN - ~Y`x IT` `a 3~ <br /> ~.+. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> " . 1 . <br />~~l z ~- <br />~, . s, r~ ~ i , <br />p . <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER (CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WIYH THE INFORM LAW qq##(HAVE PER50ryryppLLY EXAMINED AND <br />TELEPHON <br />ATION SUBMITTED HEREIN:AND BASED ON MY E DATE <br /> INOUIRV OF THOSE INDIVIWALS IMMEDIATELY RESPONSIBLE FOfl OBTAINING ~ <br /> THE INFORMATION. 1 BELIEVE THE SUBMITTED INFORMATION I$ TRUE. <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />G <br /> THE <br />PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDIN <br /> POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U S C 4 1001 AND 33 U S Q AL E7(ECUTIVE <br />SIGNATURE OF PRIN i <br /> <br />PED OR P <br />NTED § 1319. (Pepatties under IheSe sremtes may include lines up b ff0,000 e~ or <br />nd S <br />i <br />/ <br />a <br />M ~ <br />OFFICER OR AUTN RIZED AGENT A ~ <br />NUM@ ~ <br />YEAR I <br />MO DAY <br />TY <br />RI penvean <br />mon <br />S e <br />yeers.) <br />max <br />mum lmQnSOnI/ienr p <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rgje pce al/arfachments here) ". '~ - <br />TSS E ZpON LIhITS MIII 8E 8121 b'SETTLfiABLE SCLlCS LIpIT AFELI20 PCA <=lal[a,2~lEE EBEC}f `EY.ELTE TSfi~ <br />IRON E 3ETTL81H68 9CtIDS LIRITS 1ilITED Y07 aluta".:aaN PaECIR EtEli7 SUfiJICT TO 8D8ClII C.f ~;CC,t 1N I.A.2. <br />., . .a <br />EPA; ForrrT332 0 1y'iPleYioOa ~_itlon5 inay notbe Ugfl. .:`-''..rni~~ ,S'gG~S~P7~~_,. __-~ ~ O,urbIGkLMAY.,t~O'.D,y. ., En e~~~eeee+a.~.ira~ "~aE,av`'~.:~."~" SAGE .. i"OFD'- <br /> <br />FCGTT <br />