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<br />PERMITTEE NAME/ADDRESS O.dw4irWryNaWLumlm dD~l <br />NAME PONLtnr.U~•. CCICL („r;pA},Y <br />ADDRESS ROA.iSIfi C. :'.i~'_r ~ ., j FD~tTRL <br />PALI56F. CO UL <br />FACaIn <br />LOCATION <br />aTTli! .1(lMN A_ ^~~-s ~:. k4':f'I~.1T <br />NATIONAL POLLUTMT OISCNMBE EIJMINATION 9Y9TEM INPCESI~ _ - ~ ~ Fprrn ApprOVed. ~~~ <br />DISCHARGE MONITORING REPORT IDMfN 2040-0004 '~ `" ~: <br />17-r61 n-rsr POND 1C TO COAL C~' ~~~- <br />r ~~ "I e ^ o el expires 05-31-9 <br />PERMIT NUMBER DIBCHMGE NUMBER ~' U 8 R N C) 12 3 ~ 5 _ + <br />F - FINAL <br />Z ~ MONITORING PERIOD "I N O R <br />YEAR MO DAY YEAR MO DAY _ <br />FROM q u TO I aa:a tt DT SCH RrrE 1~ avr,, <br />114211 177-731 17476/ 11677/ 178-291 /3631/ NOTE: Reed GetrueE~eM3efore bletlnp tftie form. <br />PARAMETER 13 Grd Onlyl QUANTITY OR LOADING 11 Grd Onryl QUANTITY OR CONCENTRATION NG FREQUENCY SAMPLE <br />!31.371 146-531 1546/1 138-15 /4653 154671 EX OF TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />Is7-s~! MALrss <br />/6468) <br />169-701 <br />IL AND ~iREA$E SAMPLE 04CUOG t 94~ 04+POi•0 Ct0#G94 'a 00P'-rC <br />Y 1317 A L MEASUREMENT <br /> <br />D4U06 L 0 U <br />PERMIT , <br />. 'P islR SJf 1i <br />~ <br />. 7i8~C3BfT ~ <br />1:$=1 <br />PltiatlF~p?(< . s• <br />. 1N$tPa Q9! <br />'~RJS ~tNDQ. I <br />.. <br />Cbtd <br /> <br />$ <br />. <br />S <br />~,~$A <br /> <br />. U N :REQU.IREMENT. <br /> <br />.. :.: :.... ....... .. <br />: <br />::t ... ............ ~ ... :....... .. <br />:.~ :. <br />..... .... ... .:. <br />-. :: ..:.: ~.. ~. <br />:.: . <~r« <br />- ~ ~ SAMPLE . <br />~t <br />• MEASUREMENT <br />•... '. ' <br /> <br />;,;:::PERMIT:: ~: ~~ ,_~:. . <br />....:.:.~:- ~•.~.:.: _....... <br />:.~.F : :.... .: ....:~ <br /> ~R <br />E <br />QUIREMENT :. :... ~: ~ <br />. . '.::..~ :..,. .,. :.. - <br /> .. <br />. <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> . :PERMIT <br />C <br />~ <br />~ <br />;~• <br /> :REQUIREMENT - ~ <br />::L <br />~ ~ ~ ~ t~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT: ~ ~ <br />~ <br />~ t;~ <br /> :REQUIREMENT <br />.... ~ <br />~ ~~ <br /> SAMPLE <br /> MEASUREMENT - <br /> :PERMIT ~. ~ :. .. . . ~ <br />; ... ~. • <br /> REQUIREMENT .~ :. <br />. <br />Vii:: - :: ~::'is?;.5:: :~. ~~ ~~ .::~k. °. . <br /> SAMPLE ~ ~~ <br /> MEASUREMENT <br /> PERMIT.. <br />... <br />, ~ ~ ~ ~ ~ . <br /> <br />:REQUIREMENT <br />, . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . <br />~ <br /> REQUIREMENT' <br />~ ~ . : ~ .' <br />: ~.~ .. .. ~ ~ .. <br />NAME/i1TLE PRINCIPAL EXECUTNE OFFICER I cERTIFr uNOER PENALTr of <br />N <br />F <br />N uw TNAr I NAVE PERSONALLr ExAMINEO MG <br />REI <br />I <br />O TELEPHONE DATE <br />Q ~ <br />W!G G F ~~ ~~~~C// ~J ~" MDINDUKe MM <br />EDIT ELY <br />RE PONSIBLE <br />FOR <br />MY <br />INOUIIIY OF <br />THOSE <br />OBTNNING THE INF011MATON, I BELIEVE THE BUBMITTED INFORMATION IS <br /> TRUE, ACCUMTE MO COMPLETE. I AM AWME THAT TNERE ME <br />GIGNIFILMT PENALTIEB FOR eUBMITTING FALSE INFORMATION <br />INCLUDING <br />n ~ <br />1C:y . <br />THE POSSIBILITr OF RNE MD IMPRI90NMENT. BEE 1B U.e.C. ! 1001 MD 3] ~ <br />~ <br />SIGNATURE OF P111NCIPAL E , u ~w / <br />Y - <br /> u.S.C. 1 t ate. IPrWdr1 utlr Mr mroror mrT hr1.w rws W ro Jr0,000 AR A <br />TYPED OR PRINTED wnmuhxnr inpicwtrrntWNrwrw+enwrdu.nd6rwA/ OFFICER OR AUTHORQED AOEM <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANT VIOLATIONS lRererence e// etreCnmenb ner~/ <br />SETTLEABLt 50I.IOSS LINII APPLIES UhLY IF G=lUTRE24HH PRBCIPITATICN F.VEAT IS CLATFED. PEhyIT7EE HAS <br />bURUZN OF PflUOF YtIEH nC.w1UF5TING RELIf:F FROG :TESTLEAI3LE 50LZD5 PHINAR2 LIl1ITATIONS. <br />EPA Form 3320.1 (08.951 PraNioue editlone mey be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) PAGE <br />00690/4EC223-1356 ?. <br />F1 <br />~~ <br />1091 <br />r <br />