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PERMITTEE NAME/ADDRESS pnclude Faclliry Nmndlncanon ijDignenq
<br />NAME CY E':r ilC vgy~t .-.-_ ~~~. ^1yn~
<br />ADDRESS ~'! I N :: - t , ) ~ 7 _ - -' ~ ' ^ tr r s -I p ~e
<br />FACILITY
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<br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR~
<br />R46) (tr- 91
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<br />PERMIT NUMBER DISCHARGE NUMREfl
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ 'I-` TO ''' -
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<br />Form Approved.
<br />„ ~ T ,~ ,., OMB No. 2040-0004
<br />Approval e>~ires 0531-98
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<br />~NOTE: Read Instructions befo co leting this form.
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<br />PARAMETER (as-ss 5a-fit (39<5) (as-ss) (5•t-6t) EX oP TYPE
<br />(32-3n AVERAGE MAXIMUM UNRS MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAME/TITLE PRINCIPAL E%ECUTNE OFFICER I CERTIFY UNDER PENALTY OF
<br />AM FAMILIAR WRH THE INFORM LAW THAT I HAVE PERSONALLY EXAMINED AND
<br />ATION SUBMITTED HEREIN
<br />AND BASED ON M1' TELEPHONE DATE
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<br />I)(B INQUIRY OF THOSE INDMDUAL
<br />THE INFORMATION
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<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE SUBMITTED INFORMATION IS TRUE, ~~
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<br />r~~ PENALTIES FOR SUSMRTN G FALSE INFORMATION,
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<br /> POSSIBILITY OF FINE AND IMPR ISONMENT. SEE le U.S.C. $ t001 AND 33 U.S.C. SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />TYPED OR PRINTED § 1318. (Perrettiw uiMer Nasa sbfM&t may /nclutle lures up b f10,060 entl w
<br />maximum impnsonmenl of SSMeenBmonrrtt entl fiyears.) OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLJWATION OF ANY VIOLA I IONS (lie/erence all 8f(aCnmenfS neleJ
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<br />ERA Form 3320.1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NO7 BE USED.) ,~ n f ~ :, / ~ T O II T 't_+ ; 7 q PAGE ~ OF
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