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PERMDTEE NAME/ADDRESS /IMlude Paciliry xmnrl/.ocanon ijDigerenq
<br />NAME CYPRUS [A7PA vALL?[ 'DAL ^•7RP.
<br />ADDRESS9INf•;5 1,2';3 SOOTII, ECRI7AK PR
<br />91DU BAST ~Iu':RAT. CIvCLF
<br />6KGLFPDDD C7 901ST
<br />FACILITY
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<br />ATT4: t+~^P7~ 1. '(°~l.°7, :°j1RRA(. 4°4[
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (IJPDES)
<br />DISCHARGE MONITORING REPORT (DMg11
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM L t n i l i TO i., ~}
<br />(2x211 (22-z3) (24-231 (262]) RB-z91 (3031)
<br />Fonn Approved.
<br />,1 , T „ ^ OMB No. 2040-0004
<br />Approval expires 0531-98
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<br />NAME?RLE PRINCIPAL EXECUTIVE OFFICER I GERnF1' UNDER PENALTY OF
<br />AM FAMILIAR WITH THE INFORM UW THAT 1 HAVE PERSONALLY EXAMINED AND
<br />AND BASED ON MY
<br />ATION SUBMITTED HEREIN TELEPHONE DATE
<br /> INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION
<br />I BELIEV :
<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE BUBMRTED INFORMATION IS TRUE,
<br />97D 87D-2]~2
<br />Richard Mills ,
<br />ACCURATE AND COMPLETE I AM AWARE THAT THERE ME SIGNIFlCANT ~~~
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<br />tnv 1 ronmental Manager PENALTIES FOR SUBMTTPN
<br />POSSIBILftt OF FINE AND IMPR CL
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<br />G FALSE INFORMA
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<br />ISONMENT. SEE 19 U.S.C. § 1001 AND 33 U.S.C.
<br />y SIGNATURE OF PRINCIPAL E]CECUTNE
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<br />TYPED OR PRINTED ~m m i~mn~~iune~ or oe~nl%en~arcn.~nre ~ trrres up ro S10,aLb end w
<br />^ leers.l OFFCER OR AUfF10RIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reverence ell attachments Here)
<br />ALTSH!IAT~, LI!7LTS FOR TSS SET*Lf?pBLE 37LID5 (17C •7•) ev^LT ~"I L[ TP C= 1~-vr• ^n_NV nvrrTo n,VR4T rc
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<br />EPA Form 3340.1 (05-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) O D? L O ~ ~ 0 ^ tl1 ?-T ~ ? Ii PAGE ,n OF ,
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