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PERMITTEE NAME/ADDRESS Ondudc Forilih A'omdLarurun i/oigr~enq <br />NAME CYFAUS Er!FIAt C.CfPCRATICi. <br />ADDRESSGAGLi MIME CCCPIeY <br />P. C. BCX 6tl <br />FACILITY C ii A I l:, C C 816 2 6 <br />LOCATION <br />A'C ~9: A~LG °.G i. ? VAdCI, V.F. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES/ FOrm Approved. <br />DISCHARGE MONITORING REPORT (DMq; OMB No. 2040-0004 <br />(z r61 !°- s/ ~ I h C F Approval expires 05-31-98 <br />r ut ? (BUSH s~) <br />PERMIT NUMBER-, DISCHARGE NUMBER `: ~ f I ! ! I Y.C f -'I <br />MONITORING PERIOD_ ~ I S _ F w'I b E f f f P/ ~ I I l I A Y 5 f A <br />Y MO DAY YEAR. MO DAY <br />FROM I UI TO ~ C ^~' i+L L1_`CtAFGE ~__) ~~+ <br />(zo-z z1a1 R<zs) Izs$y)~ (zB zsJ t3D~v1 . ~ NOTE: Read Instructions before completing this form. <br /> (3 Card Onryl QUANTITY OR LOADING (4 Card Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4s-53) (54-67) (38-45) (4s-53) (54-67) EX of TYPE <br />(3237) AVERAGE MAXIMUM UNITS ~~ '', , MINIMUM AVERAGE MAXIMUM UNITS <br />(62-531 ANALYSIS <br />(fi4-fib) <br />69-7D <br />CiL AVU GhEASiE SAMPLE ;fir::;':, <br />~ O I 'i4) #0~t>a Ot Dt:4 „~ . , . <br />O <br />/~ <br />V~$u~{ <br />VI:i I]nL MEASUREMENT <br />c4UbL 1 C' C @E[iM1T an4~R4 r~' Q 1 E` <br />~ 7~i7~ ~, i/?0?0';~i '~ ;~'~ -ti EEISIY 1_UEL <br />~F'F'Ll)4;NT GROSS VALUE ~FIEO'EiIR~MENT - „- =,t~i$-1' MAY fC-%; :'~ ~ ~ ~ 'Y+% <br /> SAMPLE A~^ <br /> MEASUREMENT "`~ <br />' <br /> PERMIT ~ .. „, <br />~ <br />- <br /> ,REQUIREMENT ~ -r r" <br />, _ - <br /> SAMPLE `'S. ~ a:. <br /> MEASUREMENT ~~'~~ <br /> PERMIT r ~~"'}~ <br /> REQUIREMENT p ~"' <br />~s.l `3,y * ' <br /> SAMPLE <br /> MEASUREMENT <br /> ,. ~ PERMIT cr ~, y' t :ra„ . <br /> REf,IUIRFnkAHNT ~ <br /> r <br /> SAMPLE <br /> MEASUREMENT <br /> PLRM11' ~ ~ I ~',"=~a~` <br /> AEQUIREAAQNi I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ - ~.;r~': <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> REQUIREMENT .. ~>< ,-: <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND <br />N MY <br />D H <br />R <br />D 9 <br />ED - TELEPHONE DATE <br /> EIN, AN <br />AS <br />AM FAMILIAR WITH THE INFORMATION SUBMITTE <br />E <br />O <br />' INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING ~~ <br />Richard Mllis THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION I$ TRUE, /~(/J 9]O-B 7U-I7II <br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT <br />NCLUDING THE <br />BMITT <br />AL <br />E <br />RMAT <br />ON '~C <br />~~ <br />' <br />FnvirOnmental Manager ING F <br />INFO <br />I <br />, I <br />PENALTIES FOR SU <br />S _ <br />a <br />7 <br /> POSSIBILRY OF FINE AND IMPRISONMENT. SEE to U.S.C. § 10D1 AND 33 U.S C SIGNATURE OF PRINCIPAL E%ECUTIVE T/~' / ` <br /> <br />TYPED OR PRINTED 4 t3t9. (Penellies untla• these s1elNes may include Gna up ro Er0,000 antl m <br />merimum ~mpnsonment ol6aMreen6monfhs ends years.) OFFICER OR AUTHORIZED AGENT AREA <br />p <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANANON OF ANY VIOLAI IUN5 (Helerence all artacnmentS nere) <br />fiCd LICiIT APFLLES 1C CC,";i'INeC ELG+I FkGY C03, 1121 ~ C14. CIL is GkEk°F CFAc 3Af:EIE PAnIYil~ EE(l1FL: ;t <br />VI:;It1LF SRttN IS CE~Ff4cC. ~AYELY SARPLIAC INSIRCCTICNS-I.C.d, F~ X. <br />EPA Form 33T0~`1 `(Q~?95 ,^: Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />CC 371/!000]11-1C-2C 1 <br />r ~,: ~,' <br />