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PERMITTEE NAME/ADDRESS pr~d.AFerWryNwdLocauon dDlp..wq <br />NAME CYPRUS EMPIRt ClikNDKAifUN <br />ADDRESS {T~ 3~j dUx bIj <br />~L~a:RAIG Cu a1tL~ <br />F^auTY:C'/PRU S~ EMPIRE CQVtPUKAT l'UN <br />LocAnoNCiiAIG GU tiiG2'~ <br />ATTN MICHAEL w. LUDLGw, GENEKAL M4k <br />PARAMETER 13 qrd Only <br />FROM <br />'''A RAGE MA%IMUM <br />UIL AND bI:EASE SAMPLE ##{~,~~ <br />.. <br />Y L SUAL MEASUREMENT <br />~':~'.P MITE. <br />ER <br />,# pit 1t <br />REQUIREMENT: ~ ~ ~ ~ *~ <br />EFrLUEni GROSS YaLUE -: ..:.. ...: '~N5`t.::JN <br /> <br />IT:~ ~ :~'::::. -~: <br /> <br />SAMPLE <br />1SUREMENT <br />PERM+T~•.::: <br />1U1..pE.MEf•1T::. ~' <br /> soro <br /> M~IMUM <br /> <br /> <br />S t ~'Y <br /> <br />~ <br />~ <br /> ..:, <br />~., ~ ~:z <br />.: ,:;.: <br /> <br /> <br /> <br /> <br /> r ~: <br /> ii' <br />':~`:;! <br /> <br />' ..( <br />, <br /> <br /> ~i.. <br /> ;~';:3'. :~1. <br />~° <br /> %'e k <br />ids <br /> <br /> ,:.~ . <br /> <br /> ~4„ <br />VPDES/ Form Approved. <br />t1 <br />r <br />nwN>= 6 5N-9Iw Tu 0A~Br~o ~C}40-0004. <br />1CppfaSelle zje0y=3't"9s <br />~ <br /> SUdk Nd ~4`~ <br />L[ <br />,LUMBER F _ FINAL <br /> F11 NUK <br />DAY <br />it <br />+~~+~ nLl DISCHARGE <br />+~+~~' <br />1 (3x311 NOTE: R••d Irutruetloro b•1 or• coinpllitlnB th4 form. <br />fY OR CONCENTRATION NOL FRwuENCY SAMPLE <br />(4653 (6,-61 EX' OF ~ <br />MALYSIS TYPE <br />AVERAGE MAXIMUM UNITS ~ (e7~aal 16E-5ei l6'&70l <br />#~44### ~ #####,z <br />...~ <br />.; <br /> <br />. <br />~ <br /> :::;:3 . . ...:.: <br />.:.: <br />.:. <br />.' .. .. :.... ;c. :::: <br />~.Y::~:':......': <br /> = <br /> ~ + ~ 1 <br /> <br /> <br />..... .. .. :I:en.:.:•:5. <br />.:c. <br />.........::i't.~.. .. .::~: <br />w <br />~~ {'~~ 'i:l.. <br />"'~!l :i::>:.: is <br />NAME/TITLE PRINCIPAL EXECUTNE.OFFICER I CERTIFY UNDER PENALTY OF LAV{THAI' I HAVE PERSONALLY E%AMINED MD TELEPHONE PATE <br />AM FAMILIM WITH iryE INFORMATION SUBMITTED HEREIN: MD BASED ON <br />MY 1NOUIRY OF THOSE...T NDIVIDUAL9 IMMEDIATELY RESPONSIBLE FOR <br />OBTNNINO THE INFOBMA•y~N,..l REDEYE THE SUBMITTED INFORMATION IS /~ /l <br />RIChaE'(1 MIIIS TRUE; ACCUMTE AND MPLETE. t AM AWME THAT THERE ME <br />SIONIRCMT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING <br />T ~ I IYI naae r THE POSSIBILITY OF PINE ANQ, IMPRISONMENT. SEE iB U.S.C. , 1001 AND SG 7 - Q <br />U.S.C. 1 tJ1,. IFrlnw. M~rN..~ Nrw mnm. nvr L'IeAw ntw w ro F1D,DD0 BIONATtJRE OF PRINCIPAL E7(ECU7NE <br />TYPED OR PRINTED .nsnmuimwr hrpiwwlwrt'olMfwwn emmU. rWerrs/ OFFICER OR AUTHORIZED ADENT CODE NUMBER YEAR .MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRdernc. •l/AtFechm.nte h.rel ' <br />~ETTLtAESLt SOLIDS L1M[T rrAiYtU FUk lOYREZ4Hri P~ZECiP EVENT-Stt I.A. j, PG 1V, fUk kEUUIRENENIS• LIL G <br />~RtASE GkAii SAMPLt ANALYSIS kt~ULRt:U IF YISLBLE SHtEN IS UdSEKYEO. gkTkLY SAnPLINU LNSTRUCTIUNS-L.L..~, <br />u r_ <br />EPA Form 3320-T 108.961 Previow editiom mey be wed. (REPLACES EPA FORM T~0 WHICH MAY NOT BE USED.1 OOGUy/y61UU1-I31 I PAGE LOF <br />