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PERMITTEE NAME/ADDRESS pndude Fnrilily A'ume/Lnrarion gDlgerenq NA <br />NAME <br />CYPRu~ ECFISt CCrf•CnA?Il:t. <br />ADDRESSEAGLc ,7IM1L CCP.FI:Y <br />P.G. dCX 6d <br />FACILITY CRAIG 'CG 81626 <br />LOCATION . "" ~?. <br />a FROM <br />A P1'h: :,G EG kG t. t_ vA ;r~_ v_n_~ <br />- ..,>~. <br />LUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) Form Approvetl. <br />'HARGE MONRORING REPORT (OMB; OMR No. 2040-0004 <br />1z 16/ (n g) <br />r,• t' I R C f. <br />ISUEe Approval expires 0531.98 <br />r4) <br />T NUMBER DISCHARGE NUMBER F - ~~ F I [~ I[ l: C F A 9 <br />MONITORING PERIOD N C. i, L P 11. E T C Y I I I I P C_ F C I M F Y <br />MO DAY YEAR MO DAY _ _ <br />C3 0] L'u _; '•>kY 4C L1`_ChA.FCE I__I <Ci <br />rzz z31 +z4.s1 n6~zn rze zPl (9o-3+1 NOTE: Read Instructions before completing Ihis loan. <br /> (3 Ceni Onry) QUANTITY OR LOADING ld Only) QUANTITY OR CONCENTRATION NO. FREOL'ENCY SAMPLE <br />PARAMETER (/16:5~3)~.P' (5461) ~ (38-45) (4658) (54-61) EX OF TYPE <br />(3237) AVERACn~' MAXIMUM UNI MINIMUM AVERAGE MAXIMUM UNITS <br />fE2~un ANALYSIS <br />ls4-6B1 <br />69-70 <br />SOLI US, T.':?'AL SAMPLE ,•, <br />'?4Cyl fir, r. ;::};: .,,... AIDT ~ ( 75) 0 <br />D ISSCL~ rG MEASUREMENT . tLcSTEA T STE ' ~ ~ "A <br />/I:LyS 1 U V PERMIT C:110 -k4>O~I~tiF', X:;: B+@ fIEPi RT Cf #IL 31~j. 813° flE; <br />cF)LUt!:T GdGS° VFLL; REQUIREMfsNT ., <br />t z~,xy i <br />tE AYG <br />S.~• NE <br />tG I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT, °" <br />~ <br />• <br /> REQUIREMENT _( ^ i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - "r - - ~ #'~ . <br /> REQUIREMENT ~ -C <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -" ~r <br /> 'REQUIREMENT ~ >~{;1? ~ "e~. ' <br /> SAMPLE <br /> MEASUREMENT <br /> `..:PERMIT " <br /> . P,EQUIREMENT - " <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . <br />~1 <br /> REQUIREMENT .; + 4'~ <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMLT• ' <br /> AEQ~IREwI~NT ~ I <br />NAME?ITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNOEfl PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND <br />M FAMILIAR W <br />TH THE INF <br />RMATION <br />BMITTED <br />EREIN <br />AND e/5E0 ON MY TELEPHONE DATE <br /> A <br />I <br />H <br />: <br />O <br />SU <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY flESPONSIBLE FOR OBTAINING , <br />' <br />~ <br />Richarri ~lilis THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br />THER <br />NT <br />C <br />S <br />G <br />97D B7O-271 <br /> ACCURATE AND <br />OMPLETE. I AM AWARE THAT <br />E ARE <br />I <br />NIFICA <br />PE <br />TIES F <br />NG FA <br />E INFORM <br />TION <br />INCLUDING THE <br />R SUBM <br />TT ~ <br />~ <br />F:nvironm?ntal Mananer NAL <br />I <br />I <br />LS <br />A <br />. <br />O ., ~y~ <br /> POSSIBILITY OF FINE AND IMPRISONMENT. SEE to U.S.C. § 1001 AND 33 U.S C. SIGNATURE OF PRINCIPAL E%ECUTIVE W <br />TYPED OR PRINTED muinrumh~sonmerolbeN.een6months entl 5utle fines up ro Ef0,000 antl or <br />p rears) OFFICER OR AUTHORIZED AGENT AEA <br />cooE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />GOMMEN I S AND tXPLANA I IUN OF ANY VIULA I TUNS (HelerenCa all eReCnmenlB here) <br />FLGi: LICIT APPLIES YC CCnEIt~ED FLL4 FFCI". CC?, ,22 f 024. CIL b Gi1EA_`b GFA2 SAY.FLE Ai1AI1579 ff(L1PFL IF <br />YISIBLh ShEEt~ IS CE.FFYED. ~HTFLI 5ACFLIAG IhETFLC?ICNS-I.C.S, FC Y. <br />_ F- <br />EPA Form 3320-1 (OB-95) Previous.;@djtiopsspay. not be Us@d. (REPLACES EPA.FORM T-40 WHICH MAY NOT BE.USED.) PAGE OF <br />