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PERMITTEE NAME/ADDRESS (Include Faciliry Name/LOCaiion iJDi$erenq NAME C1YiP^11:- Yn ••.~6 /~.- •. -^1;!. ...7 .a P. ADDRESSEI I `.~ "' S 1 , l ~". [ - -• r, • ~, ~ c r. ~ q ~ `1 F' t:rlSl.r.d~'J ^n a~15S FACILITY LOCATION NATIONAL POLLUTANT DISCHARGE EIJMINATION SYSTEM (NPDES) Form Approved. DISCHARGE MONITORING REPORT (DMR~ OMB No. 2040-0004 (Z-161 (1]- 91 ~ ~ ~ 1 -. "! 7 1 71 `. X 1 n' 1 / ' n n ~ •t ~ ~ t ApProvel expires 05-31-98 PERMIT NUMBER DISCHARGE NUMBER ~• r T .• A . u ~ ~t ^ ~ MONITORING PERIOD `Tr' ~ ~ ~ne~ T -"? F-~T r',-. """ YEAR MO DAY YEAR MO DAY FROM r) ')" rL TO 'j° •7•. .~` Hl nr Sf•"SO.. r. I ( ~.;;5 fzaz0 (zz-z3) (z.-zs) (zav) paze) f3a3/) l-NOTE: Read Instructions befo completing this }on)1. (3 CeN Ony) QUANTITY OR LOADING (4 Card Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE PARAMETER (46-53 (54-81 (3ed5) (4653) (54-8/) EX OF TYPE (32J7) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~ s 6& (sz-~) 6e) 70 ,: -~rN, -CJ CAI' SAMPLE .-'~r--. r:- x~;.~~.. r..A.....~ ( ~ p) (A S )' E I MEASUREMENT S, .L'.laS 1 T! ~ PERMIT, ~. E #i, 91_. #;t ~- ti~tlc10rN '., E+. V 1'.^ ~ REQUIREMENT :;,,,, : v~~~ -: ... ::.3Q1!#. 6t$.'. II~S. • h~s, •••7!T. •. {~ I ~yr,l yJ~, N L N. SAMPLE ( D3) ?'zArt ~^ ~-Xrt;t ~:~ xe#3t~s ::{ 4 D T R F. A T" F II P^ L 7 `• " MEASUREMENT 7 .0, i15U 1 D 7 PERMIT , t: ~~ ~ ~. ~' e '~~ • _ #`' `^ ~~ -`•~LDE?lT DF7Si '/°'. REQUIREMENT { ' A~~~ ~*Q ~ 1X~~.'!1.') ll,~ - !1 G D s C ~".` ~. x '",` ,- `r" -t.±Y L, L N) .. .,.IISF SAMPLE r.:::r :.r ( oq) .':#«r .~*~ ..fi......, Y I i ll { L MEASUREMENT 34U66 1 D S PERMIT $.^.##P#'. :"'e ~ - * rS=1 ~ #fiNkm+i# '. ##Y§#~RO >.k¢ Or- ~ $ E1(Jrr''<' ~ '~ ::FF~LUEYT f;u1i i ~!) S 11>' REQUIREMENT jS-J'~ .~. V,7=(! .. , SAMPLE MEASUREMENT PERMIT ~~;; {~ REOUIREMENT `-: =n :~ SAMPLE MEASUREMENT PERMIT - ` . q .~. r . ,,_• r ~~ . ~` REQUIREMENT 1- ;x y -'~ ' ~ "Te; - - - - - .,'.~=~ SAMPLE MEASUREMENT PERMIT - - -- -- :F= 'q)<-- REQUIREMENT ~ ~ ~` - SAMPLE MEASUREMENT PERMIT . ., REQUIREMENT xl_ NAME/TffLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF AM FAMILIAR WITH THE INFORM LAW THAT I HAVE PERSO ATION SUBMITTED HEflE NALLY E%AMINEO AND IN; AND BASED ON MV ' TELEPHONE DATE INQUIRY OF THOSE INDNIDUAL S IMMEDIATELY RESPON SIBLE FOR OBTAINING . r; L- r IG ~1YC' i ^III THE INFORMATION, I BELIEV E THE SUBMITTED IN FORMATION IS TRUE, ' ~~ _ ACCURATE AND COMPLETE. PENALTIES FOR SUBMITTIN I AM AWARE THAT TH G FALSE INFORMATIO ERE ARE SIGNIFICANT INCLUDING THE N I `"""-dry G 571-SI7D .'71, R 'O l-_]1t8I r s°~-~'^Y i1V1 , as g9 , POSSIBILITY OF FINE AND IMPR § 1319 Ri d th P ISONMENT. SEE 18 U.S.C. § 1001 AND 33 U.S.C. mhn I l d l/ ro 510 000 d SIGNATURE OF PRINCIPAL EXECUTIVE TYPED OR PRINTED es un er ese s es may nc u e ~tac up , en or . ( ero mesimum tmprisonmerx of Sehveen8motrtlu vMSyeers ) OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY . D COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re7erence ell attachments here) .:L. :1'•AT ., LT"Ir; c-rc S, C4'J'1 SF"P'.'§1T, ~' :7LT1"' (L7' "T+) e~>ry 1.•S ), rc i_ Tn_v c~ nt_7v oo;••-r•, u- Ci.:;,"x'G. ;Se' S.. 4. i''1 L-' v7i1 d0a'1SY ~° P3 7 onryrT P~t^ ,1 rar _ - r1 i V .9f r g r n l•Tn EPA Form 3320-1 (OSA5) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.) ,r ~ t ~ j ~ O T ~• rt, ~ _ r r -)1. PAGE _ OF