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PERMITTEE NAME/ADDRESS !include Farilisy.Vamdlncafion if L ifferrnfi <br />NAME <br />ADDRESS <br />?rfu ICJ >3263? <br />FACILITY =- ;A MINE COQ IF'f_EX <br />LOCATION `- CID 81635 <br />KAR91 ; RtF-CLAMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO D <br />I I <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />;'1(.. <br />M • <br />F <br />D5%'t-tip TU i ;; i /t?hiAS Y "KF_EK <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO- FREOUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />J <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ' <br /> MEASUREMENT - 1 <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I certify under penaity of In% that this document and all attachment, were <br />d <br />d <br />di <br />i <br />TELEPHONE <br />DATE <br /> prepare <br />un <br />er my <br />rect <br />un or.upenision in accordance with a system designed <br /> it) assure that yuaiiried personnel properly gather and csal ale the information <br /> submitted. Based tin my inquiry of the person or persona who manage the system. <br /> or those persons directis responsible for gathering the information, the information - , <br /> submiu.d is, it, the inert or my knowledge and belief, true, accurate, and complete. <br /> <br />1 :ono -are that there an. ipnincam penalties for auhmiuing false information, <br />SIGNATU E OF PRINCIPAL EXECUTIVE r <br /> <br />` <br />TYPED OR PRINTED inclndnttz the possihihts of font ind imprisonment for knowing violations. OFF[ R OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used 0011- 1 niti is a 4-part fonn.