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<br />PERMITTEE NAME/ADDRESS /include Facility Name/[ocartoni D1 erenr
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.. /~~
<br />04
<br />S B G .a' p COAL C C FI F I FI Y DISCHARGE MONITORING REPORT (DMR;)
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<br />Approval expires OS-31-9
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<br />ATTt;: G. dUU EftU".!. LEAE!,pL MANAGER lPaz1) !2223) rpq, (26-2rJ (29~Y9) Boar) :Read Instructions before completing this form.
<br /> (3 Card Onry) pUANTITY OR LOADING erd Onry) GUANTITY OR CO NTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (4&53) (54-61) (3a-45) (46-53) (54-511 EX OF TYPE
<br />(32-37) AVERAGE MAXIMUM U MINIMUM ~ AVERAGE MAXIMUM UNITS
<br />lsz~631 ANALYSIS
<br />(64-5e)
<br />69-70
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<br />SAMPLE
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<br />:FFLULIiT GROSS YBLUE ' EQUIRpMENT '
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<br />LL AN[r GHElSE SAMPLE 4C>} a;+aa ;.tXy~t+ CrCLAaa ( 15)
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<br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY ENAMINED AND
<br />O
<br />MY TELEPHONE DATE
<br /> AM FAMILIAR WITH THE INFORMATION SUBMnTED HERE
<br />INONRV OF THOSE INDIVIDUALS IMMEDIATELY REBPON N
<br />IN; AND BASED
<br />SIBLE FOR OBTAINING
<br /> THE INFORMATION, 1 BELIEVE THE SUBMITTED IN FORMATION IS TRUE.
<br /> ACCURATE ANO COMPLETE I AM AWARE THAT TH
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<br />R ERE ARE SIGNIFICANT
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<br /> PENALTIES FOR SUBMITTING F
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<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1e U S C 4 1001 AND 33 U S.C. SIGNATURE OF PRIN IPAL EXECUTIVE
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<br />TYPED OR PRINTED § 1319- (Penatlias urMer these slalules mey include tines up l0 510,000 entl or
<br />mexlmum lmpnsonment of beMeen6mOnlhs and SYears.) OFFICER OR ALIT RIZED AGENT
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) -
<br />Is:; o IRON LIr,LTS LILI HE; MAIYEC S SETTLEAI?lF. SOL][5 LICI: A6FiIE1 fCh <=1D 1f 4, 24t!b FkEClI EYE FT; T£_°Q,
<br />18UN 6 5ETTLEABL~ SOLIDS LIt1IT5 YAIYED FOR ~1U1'R,:UNR ikF.CtE' EYEAY SUE.7E:Ci TO 9U6LEH CF iACCF~I1 i.1.7.
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<br />£PA Form 3320=1 (OB-95) sPie~[gus g~itlons may no4 be Used. ( CES EPA FORM T-00 WHICH MAY NOT BE USED.) n n n . ~ • u o n e - ~ i ~ c e PAGE , OF
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