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PERM II T'E DORESS IInCI.IaY NATIONAL POLLUTAN CHARGE ELIMINATION SYSTEM I\PUh.f) DD/Ovnd <br /> iuc.un \... ll d)nrrrnl) DISCHARG JITORING REPORT IDIIR) a 2040-CC,:-: <br /> NAME— P dy Coal Company------- (17.19)124 /� 0"l expires 3,30-lb <br /> -- ---------- <br /> / <br /> ADDRESS—1 300 South Yale -----------_ F O 6 <br /> -- F1 agstaff, Arizona 8600 ------ PERMIT NUMBER DISCHARGE NUMBER <br /> ———— ——————————————— MONITORING PERIOD <br /> FACILITY—Nucl a Mine --————————— YEAR ; MO DAY YEAR ' MO DAY <br /> T <br /> --- --------- <br /> LOCAION -------------------- FROM 87 071 1 TO 67 I 09 1 30 <br /> (20-21) (22-23) (24-25) (2627) (3\-291 (30-31) NOTE: Read instructions before completing this form. <br /> (3 Card 0n0) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION I <br /> PARAMETER (46-53) (54.611 (38-45) (46-53) (54-6/) I NO FREQUENCY SAMPLE <br /> I <br /> (31-37) EX I ANAL OF ISIS TYPE <br /> >< AVERAGE MAXIMUM UNITS MINCIIMMUM AVERAGE MAXIMUM UNITS 162-6311 164-68) (6Y-70) <br /> S <br /> AMPLE <br /> ME 0 <br /> l.� l• MEASUREMENT O 01/07 V1 <br /> PERMIT 0=NO .`.fi t , <br /> REQUIREMENT <br /> fin, <br /> SAMPLE t <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> C-) MEASUREMENT <br /> 1 ' <br /> �) PER M IT - <br /> C.J REQU IREM ENT_ <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 /> 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 FOP <br /> James S. Lunan OBTAINING THE INFORMATION BELIEVE THE SUBMITTED INFORMATION <br /> IS TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG r►A'-'-P✓ w's""-r•�' <br /> Manager - Permits NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING P �/ <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SEE 18 USC 1 1001 ANC SIGNATURE O7` PRINCIPAL EXECUTIVE 602 774-5253 87 10 28 <br /> 33U­ 11319 •P.•na llu•. unar. IA.•..• .mtul.•. —, ..)m. 1..... uv I^ SLN.I•�• <br /> u <br /> TYPED OR PRINTED �..d •...nA..mum m.P.......r...•..... Mlu.+•n n m..nlh.nnA i..n..• / OFFICER OR AUTHORIZED AGENT AREA I NUMBER I YEAR I MO DAYCODE <br /> � <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Hr)rrrncr ill uUUUoarnls here) <br /> _PA Form 3320-1 (Rev. 10-79)PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br /> UNTIL SUPPLY IS EXHAUSTED <br />