HYDRO24058

• Permit No: C1981044
• IBM Index Class Name: Hydrology
• Doc Date: 1/29/1999
• Doc Name: DECEMBER 1998 DMRs
• From: CYPRUS EMPIRE CORP
• To: WQCD
• Permit Index Doc Type: DMR’s
• Media Type: D
• Archive: No

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NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I LEPTFY UNDER PENALTY OF. LAW THAT IFXAVEPERSONALLY E%AMINED MD TELEPHONE - DATE '
AM FAMIUM WITH THE INFORMATION SU6MITTjD NEREIN: AND SASED QN -
MY' INQUIRY OF. TH09E 1NDINDUAL3 ~IMMEDIATEUV RESPONSeLE FQR / '
09TNNING THE INFORMATION eEUEVETHE SU9MITTED INFORMATION 19 A , ~l ~]']~ ~
..°.ichard iv~l~~$ TRUE, ACCUIUTE MD OOM`~SLETE. I AHI AWME THAT TNERE ' E .V// j//
SIONIFICMT PENALTIES FOR SUBMIT'I'INO FALSE INFORMATION, INCLUDING
rnvironrnentai Mana.er THE POSSIBILITY OFRNEMDIMPNSONMENT,SEEIBU.S.D.It001MD3a giONATUREOFP111NCIPALEXECIRNE 970 970-2772 ~ 28 99
TYPED OR PRINTED ena n~mrr3~ ~~r ~b «^ s~i.w~rw~ ~r...s~tr IO ro Sro,000 OFFICER Oq AUTHORIZED AGENT A EA NUMBER YEAR MO DAY
CODE
COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a//attachments here/
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EPA Form 3320-1 108-951 Previous aditiona may be ueadY ~ (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) JU 1 ! b / yb L 0 U 1-1311 PAGE I OF