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PERMITTEE ADDRESS (Include NATIONAL POLLUTAN CHARGE ELIMINATION SYSTEM (NPDES) Approved <br /> factltt) Name pn if dtgerent) yyy�ryyy�/y�/�yy�/ y DISCHARG NITORING REPORT (DMR) NO,2040-0004 <br /> NAME— V�/VD ODV�YJV COAL CVO AVAA/V�/V�VXXXXA/XXXXXX V_— (2- �1 (17-19) .-Xplre52-29-84 <br /> ADDRESS XX-X,�XXXXX-XXXXXXXXX/XXXX.XyXXAA_MXXAXXX _ C0DDdUZI-3 UDZ <br /> — AXX'XxXXXX XXXXJ�X.AXXXxX PERMIT NUMBER DISCHARGE NUMBER <br /> ---- ]( Jf --------------- <br /> MONITORING PERIOD <br /> p ---------- YEAR I MO I DAY I I YEAR MO Y <br /> S �fZ_ 86001 FROM TO <br /> (20-21) (22-23) (24-25) (26 ) (2R-z9) (30-31) NOTE: Read Instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46-53) (54.61) (38-45) (46-53) (54.61) NO, FREQQUFNCY SAMPLE <br /> (32-37) EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITE 62-63) (6468) (69-70) <br /> _ SAMPLE <br /> FL^, C:r FLJc T MEASUREMENT NO DISCHARGE V- x <br /> PERMIT - M G O <br /> y! )4 Sb 7t '✓F 'k 'j. * * i♦ )1: * sE �' itt '71' 'MC ;� �,) f* ! <br /> f^� SAMPLE <br /> T <br /> Tl- 1 ,•L "_I.,.� MEASUREMENT <br /> CEFFLUECT) PvRMrr LB/DA :G/L <br /> f 3 REQUIREMENT <br /> SAMPLE <br /> IhD1-t♦TC I_*L MEASUREMENT <br /> PERMIT LB/DA y rfG/L <br /> REQUIREMENT 1l30 <br /> SAMPLE ! �f <br /> 0h,FIEL0 MEASUREMENT <br /> PERMIT - S 11 <br /> n o 4;; REQUIREMENT <br /> SAMPLE <br /> OIL g G%;E4F;E MEASUREMENT <br /> VIS64L PERMIT :rG L <br /> A !)( 2 REQUIREMENT y .* * .� yr st >rr I► * # f * 1r tk >ir r, / L L <br /> _ SAMPLE <br /> 41 UCTIVITY &/ ,R MEASUREMENT <br /> TDa CEFFLI'E T) PERMIT 4 7"4:7 r• R£gUER£MEN(T tk 'R tU' y! !I.' '71` 7; 4; :�' 71t !► W '.u' '* 'JI) * * * 'Jk !k t/9 `I 4 <br /> C-) SAMPLE <br /> I MEASUREMENT <br /> W <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR ^N/' <br /> OBTAINING THE INFORMATION 1 BELIEVE THE SUBMITTED INFORMATION <br /> H. Theodore Smith <br /> IS TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG �•C_ 6OZ <br /> Hydrologist NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SEE 10 USC 1 1001 AND SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 33 USC 1 1319 IPrnah— and,, th— ata w- may Inrlld, /Inn up lu 110 IXX. <br /> TYPED OR PRINTED a.d het—n 6 nlanth•and 5 vear.I OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br /> CODE <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS 'Re)erenre all attachments here) <br /> IF NO DISCHARGE OCCURRED DURING THIS REPORT PERIOD REPORT "NO DISCHARGE" <br /> EPA Form 3320-1 (Rev. 10-79)P EVI EDITIONR�Ty B USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ti PAGE OF <br />