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PERMITTEE NAME/ADDRESS (lncfude Fanlity NumJGicorion if Di,(Terenr)
<br />NAME C~P8U5 YA'tPA Yr.L1L'( C^9L "_OMe".
<br />ADDRESS".INES 1,1';3 3Gtr:r!, f• EC!CMAN F'K
<br />91UU £AST "lIu:4AL CLkCLF,'
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<br />FACILITY
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMRJ
<br />(146) (V~ 9)
<br />COC027154 003 q
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM vv va v.i TO vu v0 J1
<br />(N}21) (22.231 (2a~251 (26.211 (16-29) (30-31)
<br />MAJOR
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<br />Form Approved. ,I~
<br />OMB No. 2040-0004, :'; '
<br />Approval expires OS-3q'~90
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSO
<br />THE I
<br />FORMAT
<br />ON SUBMITTED HER
<br />F
<br />R WI NALLY EXAMINED AND TELEPHONE
<br />AND BASED ON MY
<br />EIN DATE
<br />F:ichard Mtlls ;
<br />AMILIA
<br />TH
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<br />AM
<br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
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<br />Environmental Manager D IN
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<br />THE INFORMATION, 1 BELIEVE THE SUBMIT
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<br />ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
<br />T
<br />
<br />970-97U-2712
<br /> PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING
<br />HE ~~
<br />(
<br /> POSSIBILITY OF FINE AND IMPRISONMENT. SEE tB U.S.C. 4 1001 AND 33 U.S.C SIGNATURE OF PRINCIPAL EXECUTIVE O
<br />
<br />TYPED OR PRINTED § 1319. (PpneMies under These smlures mBy mcWtlB Jrnos up ro E10,W0 and or
<br />maximum imprisonment or beMeen6monrhs end5yeers.) OFFICER OR AUTHORIZED AGENT EA
<br />Opp
<br />NUMBER
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<br />COMMENTS'AND EXPLANATION OF ANY VIOLA l IONS (neterence au ertacnmenrs nere)
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<br />EpA Form 3320.1 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.) 0 D :J ~ 5 / U U i) 4 C 5-15 0 L PAGE L OF
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