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PERMITTEE NAME/ADDRE$S (/nclude Farilip~ Nnmr/Larmian ifDt$erent)
<br />NAME CYPh;iS YAK?A YALLYY COfTL CO'dF.
<br />ADDRESS91N5; 1,2`-3 SCU'Id, I' E('k"Ah FH
<br />'alUU =.i5~ °IPI°.kiAL CI:iCL?
<br />FACiUN "Li.wO(lU C(i hU1S'+
<br />LOCATION
<br />AT'"7: ".J'~hIS W. KeS;LFY, '; :: t; E,FtAL ATHY
<br />NATIONAL PoLLUTAM DISCHARGE ELIMIMATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR;
<br />(1-16) (1]- B)
<br />C.%f`07.7154 CO1 A
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM v v ~. ~ u 1 TO ',, u ~i ~ .7 v
<br />(a0.P1) (Y2P3J (~4"PS) r16-2]) rZ6-Z9) (3P3])
<br />Form Approved.
<br />s. A J U 1 OMB No. 2040-0004
<br />Approval expires 05-31-98
<br />(SUED? NM)
<br />- FIFAL RRJ'i""
<br />~''X!'AN PCUU A. 1'C FGIL'FL CRF:ER
<br />:~a;: .~ . CISCHAP,G ~ FYI ar?~•
<br />NOTE: Read Instructions before completing this form.
<br /> (3 Cerd Onty) QUANTITY OR LOADING I4 Cerd Only) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (46-53) (5467) (38-45) (46-SJ) (54-61J EX OF TYPE
<br />(32-37r AVERAGE MAXIMUM UNITS h11NIMUM AVERAGE MAXIMUM UNITS ANALYSIS
<br />70
<br /> rsau~) (6a-68/ 69-
<br />L +'U9
<br />' SAMPLE t:a~=r is--.: :+.::;•['_• ,z al c. cY C:-. v
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<br />NAME/TITLE PRINCIPAL IXECUTIVE OFFICER ~ I CERTIFY UNDER PENALTY
<br />OF
<br />AM FAMILIAR WRH THE INFORM LAW THAT I HAVE PERSONALLY E)ZAMINEO ANO
<br />ATION BDBMITTED HEREIN; AND BASED ON MV TELEPHONE DATE
<br />
<br />
<br />'~ Richard Mllls
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, /
<br />
<br />/
<br />
<br />er
<br />ental Mana
<br />i ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING THE
<br />97D-87U-27]2
<br />1
<br />g
<br />ronm
<br />En4 ,
<br />POSSIBIOTV OF FINE AND IMPRISONMENT
<br />SEE IB U S C
<br />4 1001 AND 33 U
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<br />g 1319
<br />)Penettles under these slaturas may include lines up to Ef0
<br />000 end or SIGNATURE OF PRINCIPAL EXECUTIVE "- '" /
<br />
<br />~~ ~ II'f TYPED OR PRINTED .
<br />,
<br />maximum impnsonment of ber"gen6monlhs end5yeersJ OFFICER OR AUTHORRED AGENT
<br />C D
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
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<br />ID ExrtAna nclrv ul- arvr vwLa I lurvs (xererence art artacnmenrs oars)
<br />E LIPITS F08 'f5~ tJ SET1'LcAELE SO:.I05 (LOC '0') APPLY ONLY IF <= 1?-'! , Z4-;~;, SCI^ Y"•. MT IS
<br />;e:6 I"A.2, FG 1H, FOR 6URUF.h L~F Pq'~OF 9F;~JIn°%F.NSS. :IL :, _ .- --- -"^ p/~ :~ ~,
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<br />"Form 3320.1 (OS-yal rrewous eaRlons may not oe usea. tHertnvts erA rOnm I ~u wnwn mwY rvv I nt useu.) ; • i) r,1 2 / .. C i 4 v `. -1 `~ :; 1 PAGE OF
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