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PERMITTEE /ADDRESS (Include NATIONAL POLLUTA CHARGE ELIMINATION SYSTEM (NPDES) IApproved <br /> fac•tbit ham an if dlgerent) CO �y DISCHARG NITORING REPORT (DMR) <br /> NAME 1 -A80DY COAL. C XXXXXXX X X X (2-161 17-19) Opines 29-84 04 <br /> —— �c V V p �V v—�——— ( Expires 2-29-84 <br /> ADDRESS--XU&MUX_XXXXXXXXXXXLX-KX—UXXJ(XXXX —_ COOOD021.3 005 <br /> __---2tX Uj XL---XX-UXXXXh_/i_------- PERMIT NUMBER DISCNARGE NUMBER <br /> —yy—yy--� ——————————————— <br /> MONITORING PERIOD <br /> yG y��ly9lytr�0ylt�1--.131 Q—S.---Y&le�_�—pCC—nn/n—�, —————————— YEAR MO DAY YEAR MO DAY <br /> U&ML-flagataf Az—R6llL!_L__--------- FROM TO <br /> (20-21) (22-23) (24-25) (26 ) (28-29) (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. FREQUENCY OF SAMPLE <br /> (32-37) EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS>< 62-63) W-68) (69-70) <br /> SAMPLE <br /> FL . �Ef'G(„ MEASUREMENT <br /> No nTSCHIRGE <br /> PERMIT ( +D <br /> C,• ..5 REQUIREMENT ,�. yI N: t 71' tk 7Y ar �► ak Tr t * t} * * * 1t' W * 1/3 <br /> SAMPLE <br /> T,—,T1 L P.1SP MEASUREMENT <br /> �FFFLUE"T.; PERMIT LD/DA (IG/L 1 I 5 E RQUIREM HNT y, * * *, �, ; ,�, * * * * * T 3 r 7 C <br /> SAMPLE <br /> 0 TCTA,1L MEASUREMENT <br /> PERMIT LB/DA y ti"G/L +fir l•1 1 OIL,13 REQUIREMHHT <br /> 7 SAMPLE <br /> PH. MEASUREMENT <br /> PERMIT S LI <br /> ' v it f(: REQUIREMENT * f ifc !rt ?I * tt j► < rj tk 1k tk # �e / I; � <br /> SAMPLE <br /> r I L G• n C MEASUREMENT * * * y <br /> V 1 S U r L .PERMIT V/L <br /> h et t� 2 REQUIREMENT * * * M' Zfr * R I► �Ic * i f Ik i^ RR <br /> SAMPLE <br /> C►+ I'TIVITY � / �� MEASUREMENT * * * X t <br /> T ci:FLt,`1 T� <br /> � PERMIT <br /> 7. :.i -• REQUIREMENT +� y, !- a► *i +k 1 'Y tF 'w II' dr i tk * 1/+ * 1/t]r C. <br /> SAMPLE <br /> C) MEASUREMENT <br /> I <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 IINDIVIDUALS <br /> A / <br /> H. Theodore Smith N I BELIEVE <br /> DI MATI <br /> QUIRY OF THOSE IN EV IMMEDIATELY RESPONSIBLE FOR <br /> OBTAINING THE INFORMATION BELIEVE THE SUBMITTED INFORON L <br /> Hydrologist S TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG <br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING <br /> THE POSSISILRY OF FINE AND IMPRISONMENT SEE 18 USC 1 1001 AND SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 33USC (11319 114nalue. under there statute, nlav mrtude fine, up to SIu IXrI <br /> TYPED OR PRINTED and Ile lnit— in lmPrlran nlenl lnf hew—n 6 mnnth.and.i sea r., OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> CODE <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> It _ a. <br /> } / t <br /> .PA Form 3320-1 (Rev. 10-79)PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED I PAt^-V, nr <br />