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PERMITTEE NAME/ADDRESS (1Mvd. F.vWryNw/loranen dDrgsmp
<br />NAME CYPR'.f'" i±~-' e 'd"[L-'~ ."'4L ^,I..P.
<br />ADDRESS Y~N.-: c, 1r_ ~', .E r~IT~3 Dr
<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM INPDESI
<br />DISCHARGE MONITORING REPORT (DMRI
<br />l1-1 el 17- 191
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<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM y i c J TO "'' I; -. ,"~-
<br />I261/1 l11-131 !1415/ 116-171 !IB-191 l3P311
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<br />Form Approved.
<br />"„ordB7rro;, zoao-oooa :. .
<br />Approval ezpirea OS-31-98
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<br />PARAMETER !3 Grd Onlyl QUANTITY OR LOADING !I Grd Onlyl QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
<br /> !46.531 15457/ 13B-45/ /t6-53 !µ6/1 DF
<br />131-371 EX
<br />µALY51S TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS rs1-esl Iµ561 169-701
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF L AW THAT I HAVE PERSONALLY E%AMINED MD TELEPHONE DATE
<br /> AM FAMILIM WITH THE INFO RMATION SUBMITTED HEREIN; MD BASED OM
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<br />EtICIIarCJ i.
<br />IIIs MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOP
<br />OBTNNINO THE INFORMATION
<br />I BELIEVE THE SUBMITTED INFORMATION IS '
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<br />ACCUMTE µD COMPLETE
<br />I AM AWME THAT TXERE ME
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<br />SIGNIRCMT PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING 9T0-870-"1712 ;:6 qo
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<br />THE POSSIBILITY OF RNE µD IMPNSONMENT. SEE t8 U.S.C. f t00t MD 3] BIONATURE OF P111NdPAL EXECU77VE
<br /> U.S.C.f t]te. //VeVdrl r/IWI UIFY .errunM rrMY YrcAAI BwaW rotIO,ODO AREA
<br />TYPED OR PRINTED ."da+,....:~.,,xw:.al"..rae.n...o e...a,m,wsY.e~l OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO ppy
<br />COMMENTS AND EXPLANATION OF ANr YwLA l lurvs lrorersnce sn srtecnmenrs here/
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<br />Epp Form 3320-1 108-951 Previous editions may ba used. (REPLACES EPA FORM Td0 WNICN MAY NOT BE USED.1 ~ ~ , ~ ~ / ~ , ~ r, ^ ~ _ : n 1 ; PAGE , OF
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