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PERYTEE NAMFJADDRESS llmieh ,.~. %':j: 1 :' '~
<br />irYlr)Nnnr/Lwano •''~ ','
<br />' NAME Pt.iL ia~COAL CC' (NUCLA~lf2M~'_~_
<br />11DORESS COU!. _ kOAU AA _,_ ' ~ _y;.~-' ~'_ _
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<br />FAaLITr --_------_.-~ ~•_ y
<br />E:7:.: C_t:AiS~S'tEVEN541+, PRESIDENT
<br />NATIONAL POLLUTANT CHARGE ELIMINATION SYSTEM (NPDESI
<br />DLSCHAR NITORING REPORT /DMR/
<br />l1-16 ll7-I9/
<br />CGODC07.1 GOS A
<br />' PERMIT NUMBER - = += DISCHARGE NUMBER
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<br />v ~_ MONITORING PERIOD
<br />VFROM YEAR MO DAY ~ YEAR MO DAY
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<br />S~OAryGAT.EA DISCHAkGE Blexplrea63DSt
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<br />NOTE: Read Instruetlons before completing tbis'form.
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<br />FREQUENCY
<br />gAMPLE
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<br />UNI75
<br />/67.67 ANALYSIS
<br />!bt-681
<br />l69-70/
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<br />F L . n_ :
<br />NAMETTITLE PRINCIPAL EXECUTIVE OFFICER ~ I CERTI
<br />AND AM FY UNDER PENALTY OF LAW THAT I HAVE P
<br />FAMILIAR WITH THE INFORMATION SUBMITT ERSONALLY E
<br />ED HEREIN: A %AMINEO
<br />ND BASED ~ _ _ -
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<br />. -TELEPHONE ~~ DATE
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<br />}'~1 +4~~ '/ ~V,L ~.L - ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR
<br />OBTAINING.7HE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION y. ..
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<br />~~~ 1 . G'•~ n T^ Ttl{~7~0.' G~ 12..4 = NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING
<br />THE P055181LT' OF FINE AND IMPRISONMENT. SEE 18 USC. 1 1001 AND
<br />} SIGNATURE OF PRINCIPA E%ECUTIVE I
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<br />096
<br />' TYPEOOR PRINTED .
<br />aMwrw4u~m N+pberwmmnro/Wrawr+bmwr/uaM bean/ OFFICER OR AUTHORIZED AGENT I NUMBER YEAR MO DAY
<br />COMMENT AND EXPLANATION OF ANY VIUUTIONS/Rl/nrna anPlteKAmenvheR/ I
<br />IF NU 0: 5CH.IRCE OCCUNS 7Ef'O:i?-:~NO~.DISCNAAGF". OIL ANU GREASE; S£E FCOT_NOTF; F/. ~- -
<br />EPA FOrrn "1L~(RBV.aBB]P/BVIOUB BOIIIOnSmSY Ds I/SBd. ~.. - (REPLACESEPA FORM TJO WHICH MAYNOT REUSED.)
<br />- OOli~7/960810-1~n0~ PACE OF I
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