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<br />NAME PII'?SBURG E MIDY~Y CDAL MINING
<br />ADDRESSE D N A 7I N E
<br />P.D. BOY b51B
<br />ENGLEYOOD CO BO155-b518
<br />FACILm
<br />L~T~bAK CREEK CO 80467
<br />~TTN: BRIAN D. GDNTARiK_ SR P.NV k:NG
<br />NATIONAL pOLLVTANT DISCNMDF ELIMINATON SYBTFM /INPDESI r
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<br />TYPED OR PRINTED !welnaln[m.pnebnll>orne.ene lmvrlvemrm fnr.ro.ln[.IWeuoln OfFICER OR ADTNORD:ED AGENT CODE NVMFIER YEAR MO DAV
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