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PERMITTE~ NAME/ADDRESS (Include Faciliry Nami/Localion fDiBerem)
<br />NAME CY2:!US YAMi`A Y.11L~Y ('OAL ~'JF.P.
<br />ADDRESSrItr F'r1 1,155 tiOUTN, ': EC.`: ~'1's f'K
<br />`1iUl~ c:A_iT *LNEf.AL CIRCLE
<br />E":GL{:000 CO tlP1S'
<br />FACILITY
<br />LOCATION
<br />AT1 :~: ^:C ~tRLS W. KF'CLEY, I:-~wc:RdL dT':Y
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR;
<br />f2-I6) It l- 9)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM u v v D v l Tp u v D ~ .:
<br />(Y0~2t1 f23~331 (14-351 R6~P) (z6-291 (30.91)
<br />Form Approved.
<br />,~ A U O , OMB No. 2040-0004
<br />Approval expires 05-31-9t3
<br />P - FI "Ah POU"Ci
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<br />NOTE: Read Insiruclions before completing this form.
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<br />PARAMETER (46-53) (5467) (38-45) (46-53) (54-61J EX OF TYPE
<br />(32.37) AVERAGE MAXIMUM UNITS MINIMUM AV A E MAXI UNITS
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E7(AMINED AND
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN' AND BASED ON MV TELEPHONE DATE
<br />
<br />Richard P.4111s INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE,
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<br />ental Mana
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<br />i ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />T ~(~ {~70_R-~~-77~ 2
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<br />PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING
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<br /> POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1a U.S C 4 1001 AND 33 U.S.C.
<br />10
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<br />M SIGNATURE OF PRINCIPAL EXECUTIVE ^
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<br />TYPED OR PRINTED § 1319. (Penatllas antler Ihese s2rutes maY uclude
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<br />maximum imprisonment al beMreen6monlhs and5yaers.) OFFICER OR AUTHORIZED AGENT AR
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<br />NUMBER
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<br />COMMENTS AND F~(PLANATION OF ANY VIOLATIONS (Relerence all attachments here)
<br />ALTE'9NA't'R. LI'1I'PS FOR T55 E ~E:TLcA3L~ SOLIDS (LOC 'O') APPLY ONLY If' <= lii-Yk, '4-,iR r,',CIP f YEN; L~
<br />L'LAIIED. 5..°.E I.A.2, YG 1N, FOn uL'h'~E.:~ OF PROOF KF;UIRENEi;PS. OIL GnEAi'--:.. -. .. -:JT' /~ p, ~,
<br />EPA Form 3320.1 (OS-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) (. U ~ r ~ r; ~ ~ y (; ; _ I ~, U 7 PAGE ~ OF .•
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