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PERMITTEE NAME/ADDRESS (Include Facility Name/location if Different)
<br />NAME e`I T':,I i!F > r F l-"!'?WAVY COAL MINIt
<br />-44
<br />'ADDRESS FHDINA MINE
<br />i 1c+ _ E STF ?{:
<br />Ill L .41r0[)D O Slew'
<br />FACILITY T r :?
<br />., LOCATION OAK l F;Fr_K CO 801-17)v
<br />ATTN: `r ? , ? F.?'a t i. ?;a ?t•K?A E"#iaTtUFF'f
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES
<br />DISCHARGE MONITORING REPORT (DMR)
<br />C 0000 2638 004 A
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />FROM
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<br />Form Approved.
<br />OMB No. 2040-0004
<br />MINOR
<br />(SUBR ,JC )
<br />F - F I NAL Rill
<br />SURFACE RUNOFF TO TROVr CREEK
<br />## NO DISCHARGE i l l #? #
<br />NOTE: Read Instructions before comoletina this form.
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<br />PRINCIPAL EXECUTIVE OFFICER ccrtityunder penauy abeuhisdocument and anatfpuh'mentswere TELEPHONE RA SE
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<br />or those persons direct] L}b,sible for gathering the, information, the information 4 "
<br /> submitted is, to the best ti'- :nowledge and belief, true, accurate, and complete.
<br />I anti aware that there a ifcant penalties for submitting false information ATURE OF P
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<br />J is TYPED OR PRINTED
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<br />ETTLHWA LE SOLIDS L.I3' IT `Wall. BF- Wit " FD FOR _`.IOYR, 24HR _PRECIP-?EN A. 2, PG. 4 FOR REQUIREMENTS.,
<br />RTRLY SAMPL.IN' G INSTRUCTIONS - s : C 0) PG. 94 form 3320-1 (Rev. 3/99) Previous editions may be used y
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<br />??^? 13, 1 C1S? '4'jI1T1. PAGE IOF
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