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PERMITTEE NAME/ADDRESS p,.iri FsdlryNwWfxwm dDi4..~p <br />NAME PUYDERHOi(N COAL CJRPANY <br />ADDRESS aOA DS IDE SINE, V `~ S PORTALS <br />P.U. P~OY LU3t; <br />PALI~ADr; CO b1S2S <br />FACILITY <br />LOCATION <br />l~TTt+: JOHN 6. `,CNA!,. k.l~'~I~:r:ST' <br /> <br />DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAV <br />FROM TO V <br />mm~ meal UL)51 v6vn ng-n9l r3a3/I <br /> <br />~~- ~~~ <br />(SUER iC) <br />F - FIMAL <br />RZNOR <br />YuY NO DISCHARGE ~~~ t^~u <br />NOTE: Rasd Instructions balorl c~ormr platln0 thin form. <br />PARAMETER !3 Grd Onlvl QUANTITY OR LOADING !1 Grd Onlyl QUANTITY OR CONCENTRATION ~ NO, mEODENCV SAMPLE <br /> !46531 /54-6EI l38<5I 1e6631 51-611 EX G <br />~ -TYPE <br />l3I-371 µ, <br />U <br />yB <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rcz-sal !µ5g1 I5s701 <br />PH SAMPLE +rC#$Lr.'>: #3###u +r:#+180 ~ I2) <br /> MEASUREMENT <br />JuOU 1 0 0 PERMIT Y~#Q'1~/CE311 t7tllNQf4+k4 #~- ~~ #aa>x#.a ~};:0 Et;KLY 'kBITU <br />EFFLUENT GR04S YALUb REQUIREMENT <br />~ULIDS, TUTAL SAMPLE -xa#al## ?CIp4#a as#### ~ ~~) <br />~USPEdDEL MEASUREMENT <br />U S 9 U I 0 0 PERMIT 0 48 dl~lla ,' <br />!::;; a~l+ra~~:: ; <br />aaa <br />*.~~~a~rt : <br />~9`. <br />T~ ...:.:... , : ?:• .: <br />a::>ti1 <br />r ti#s <br />FFLUENT GROSS YALU~ REQUIREMENT #a8a :: 3OpA'. A ` ![ H . <br />iDLI S, 38 LEA3L'e SAMPLE Ya'saua +~aaa#a a##OaA ( ZS) <br /> MEASUREMENT <br />. ti S4S 1 0 O PERMIT 0~»BSFXt?i. ;Yaq##tt - F:',L - #+4 it O.A la R6fOR1 ~ AE~.~QAT ~ ~~.~ ~AC~L/ :R~AA <br />FPLUENT GROSS YALUF. REQUIREMENT 8±Y# 30DA A9G DAI I2 !IT L L _ ~fti' H <br />IkUN, ?OTIL SAMPLE ivYVY{} ~.:a<888-,~} ###O#r. ( I9) <br />(AS lr E'~ MEASUREMENT <br />~1U45 L 0 U PERMIT ;L$¢y'f## 3ii+fbl#rl a~s8 aa~a:#a 3.5 7a0 ( NC;&~ ;RAB <br />FFLUENT GA055 VALUc REQUIREMENT ar>: 30i1A A.YG BATtT' ISY !IC X H <br />JIL AND GREASE SAMPLE uV0-;u~ ;~aacua a#aa#O ( 19) <br /> MEASUREMENT <br />J3562 1 () U PERMIT .~KLA.B# ##ixa#~% IP ;dam ;iF#?R4:IOb REPD.A; : ~:{~ ::;.:. OiTIN i$A9 <br /> <br />'Pt'LUENT GR055 YALUF <br />REQUIREIENT <br />aaa ...:. <br />.. <br />30 A AtDi': <br />::-1.1F1'Y.:LI: Y: <br />L <br />`:. <br />6$Ni <br />Oils IN COROU T OR SAMPLE ~ 03) ~aaasaa #aaI#aa ###a#a <br />iHiSU THEATMBNT PLA dT MEASUREMENT <br />T:1U50 1 D U PERMIT NEP3RT BBPOHT a.~qa#ar . :: a8A¢#a >p#taaa a#a EF.KLY :NSTAd <br />PYLUENT GROSS YALUF REQUIREMENT 30DA. A1'G. AAIL~ M7(. RGG a### <br />~ , O A SAMPLE x0##C!# 8848#4 *##'J#^• ~ 19) <br />ISSOLYED MEASUREMENT <br />7U29S 1 .O U PERMIT.:. ####~#; ##T-ala# #. L+#*+9+~# RFFCI:A'l ASF0A2 T8L2 ARAB <br />F'FLUENT GROSS VALUE REQUIREMENT, :' t?a;r8 Q.H.TF.. A;MG. : ~t(T.E. !li1X. HG/L <br />NAMERRLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFO LAW THAT I HAVE PERSONALLY EAAMINED AND <br />RMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE <br />/t <br />J • ~, S ~ c'' 4~ MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />E TH <br />T T <br />ERE <br />AE <br /> TRUE, ACCURATE AND COMPLETE. I AM AWAR <br />A <br />H <br />A <br />NT PENKTIES FOR SUBMITTING FALSE INFORMATION <br />INCLUDING <br />FIC ! <br /> , <br />SIGNI <br />A , <br />` <br />' Z¢?. ~ -E <br />O~ <br />03 <br /> THE POSSIBILITY OF pNE AND IMPNSONMENT. SEE 1B U.S.C. E 1001 AND ~] eIONATURE Of PRINCIPAL EXECUTIVE <br /> u.s.c. 1 tars. lnxrrov. u.er dwr mr.na m.v YICA.W rxw. w ro FrD,aaD <br />TYPED 011 PRINTED rww mvNxnr irlMa+'rr.+r eraw..•smonnswsr...l OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rslsrsnca s// sttschmenn here/ <br />~i;'fTLEAiiLl: SOLIDS LINIDS APPLIES ONLY IF <=lUYR,24HR PRECIPITATION EVENT I:i CLA]!'ED. P3piYI?TEE HAS <br />dUL;u~N OP PpOOF YHEN AEIUBSTING kELIEF FROH SETTLI;ADLt: SOLIDS PRI!IARY LI!NITATI065. <br />EPA Form 3320-1 108-951 Previous editions mey bs used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) 0 0 LL4 5 / 9 R C ~ 2 3-125 b PAGE I OF <br />