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PERMITTEE NAME/ADDRESS (Include Facility Name/Location i(Different) <br />NAME <br />ADDRESS OUTHF 1 EL LOADOU T <br />P.D. 4597 <br />FLOR.9...N E C0 S I P G <br />FACILITY _ <br />Elk?Ti 37 3} '? 7 illd COAL .F3v3L}I 1_I <br />LOCATION F•LORENCT.. C-21 81226 <br />h..l...r'I':i• ??T::T";Y{yp"-. tF P,V.-r"r17f:' isr'xk;, r!=IV i-Af2P <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 DAY <br />FROM ' C-d I ;:: 1. TO ?. C 12 731, <br />Form Approved. <br />OMB No. 2040-0004 <br />€°1INOR <br />(SLIBR TV) <br />-3 1 rr^', ['I GRAEFV? <br />a=i = <br />*4V•w P-;E Dl_.Sc:jHfY.?Rit3 <br />NOTE: Read Instructions bef re completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />( -f SAMPLE 3I 'E ## r i 7i #?f 4 #I 4 ?t # # t 12? <br /> MEASUREMENT <br />0- 0 •=;•C, 1 0 ±i <br />^ PERMIT r#i•?.?=,ti? s# ??k? 3???sf 6. 5 air#?k ?t `9.0 <br />F I•WICE? ?tR';£:?` <br />FFFI <br />t)ENT GROSS U REQUIREMENT IN C',$ I Mfl irl MAX .'C i'1+.1. • #°I ;fit) 'i[w5 <br />SOLIDS, SET`FLEAEL.E SAMPLE s# si K4 q tf ?• #.#'.k f= • = ii # 3d i2 3f f ( 25 3 <br /> MEASUREMENT <br />0: 545 1 0 0 PERMIT i?wF f 2 ?# # #•a ?? ? ii 3! ii 3E #3FIt-'S %F R E#=ORT 0. 7 Flic4!ICE/ sRAO <br />EFFLU NT F ROSS VALU.• REQUIREMENT 30!)r"4 At}!i Tt 3 1. N ML i L. <br />jlaGl(? ! <br />,i Altp,!L) Gf%F;iV.-'3 : SAMPLE :k: •r•-:I••-ra••, i• -•-a•:?; ??t•^•, A#:1••k-df••f• •?;• :k :'•••3# #. `:; .'Y <br /> MEASUREMENT <br />05 3582 1. 0 'Q PERMIT t ??t # s£ l? '##rt i## i? ? x :{ ?'l 3&? s #n :? i ? 0- 'ONT1N DIRAa <br />EFFLUENT R 0 S S VALUE REQUIREMENT $? f-Ea Ti eF. i?? I?°. mr? ?E? <br />i-l r# 1, OR SAMPLE ( <br />03) si ??g•31 ? t ?.tc rig sF? ??# sEvi#? <br /> <br />THRU TREATMENT PLAN MEASUREMENT <br />5 C{0511.) ". 0 c. PERMIT REPORT R' P0 R € ?##a t : #?t r'w z# :f#??t ? st x:? : rf ;ONTl.l°tB "CF°IRD <br />EFFLUENT GROSS VAi._U REQUIREMENT 3MA PMG D4 I t 51GD z?i # '.•t ! <br />,.1f:lU <br />=3 IL Ott`,ID Gil EA'SF SAMPLE ?F 3# ?#w# ( y't) ? ?S # n s# i3 sr # E?r??3f'I 3# fi 3f3l3Fd <br />VISUAL MEASUREMENT <br />S4 06 6 PERMIT REPORT 's E` =l 1t?I## ?# ?31e? ?# st It ####3 ? ? t # rw T. EE/ VISUAL <br />EFFLUENT GROSS VALUE REQUIREMENT al*l 1' MAX h.0=0 <br />Mf iF{i1: t <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTI E OFFICER I certify under penalty of law that this document and all attachments were TELEPHON E DATE <br /> <br />U © prepared under my direction or supervision in accordance with a system designed <br />to assure that qualified personnel properly gather and evaluate the information > <br />7 l <br /> <br />t / j submitted. Based on my inquiry of the person or persons who manage the system, <br />or those persons directly responsible for gathering the information <br />the information <br />7 <br />7 9 J? <br />1 I l <br />L J <br /> <br />?/ <br />T <br />C- , <br />submitted is <br />to the best of m <br />knowled <br />e and belief <br />true <br />accurate <br />and com <br />lete ? <br />(p 1 J , <br />T <br />f <br />f <br />c <br />, y <br />g <br />, <br />, <br />, <br />p <br />. <br />, <br />h <br />i <br />ifi <br />l <br />i <br />f <br />b <br />itti <br />f <br />l <br />i <br />f <br />i <br />I <br />h NATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED am aware t <br />ere are s <br />gn <br />cant pena <br />t <br />es <br />or su <br />m <br />ng <br />a <br />se <br />n <br />ormat <br />on, <br />at t <br />including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIULAI IUNS (riererence all arracnmenrs nere) <br />53ETTLEi:1AE -E S{:It.IDS 1-1 1"I" WAIVED FOR 10--YR, 24 HR PREC11" ' EVENT S4..?BJ1ECT TO BURDEN OF PROOF REQUIRE! EIN-R Tr-q <br />PART 1. B. 6. ANY ADIDITIO[4AL DAf'sr SHALL DE SUPPLIED TO THE DTIVIS10N WITHIN 4-6 HOURS, <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. PAGE OF