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PERMITTEE NAME/ADDRESS finrlude Farilin N,nnrl/n,vltun rjllif(rrr,tl. <br />NAME <br />ADDRESS <br />B 0 X 453 <br />"INIA <br />FACILITY <br />LOCATION <br />'IJIA ; <br />F._,rm Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040.000,1 <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER DISCHARGE NUMBER bEl_TA <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />i 4 FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION No. FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT > # r- -:, - h) 1 C ... <br /> REQUIREMENT .. . ,, ., •: • <br />: <br /> y <br />::u _ i , i . <br />:; ; .. <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> <br /> PERMIT ; ;? • .. -fr# r ?RAt3 <br /> REQUIREMENT <br /> SAMPLE t - ... <br /> MEASUREMENT <br /> PERMIT J <br />_ REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -:F ts• r !> -> -- <br />t. REQUIREMENT <br /> SAMPLE <br />i RFA Ti { _i',T MEASUREMENT <br /> PERMIT I=F-F'^RT i71_'r t'F-j ?.! ib l ]fJ. IfJ '?;:' Jr. <br /> REQUIREMENT -:0Jt, <br /> SAMPLE a „ :r <br /> MEASUREMENT <br /> PERMIT # FZc=.;i?-T ..- z ?J3CE. ,t <br />_ REQUIREMENT . <br />T <br /> , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 rrrnh under prnutq .•fln,. Ihul thi.d.r,rnh-nt and ill uuuchutems Herr <br />d <br />d / j TELEPHONE DATE <br /> prrparr <br />un <br />er tm dinvlion nr wlxn iron in arrnnluncr „ilh .r yHrm drtmd <br />..I .. ; 1, 10; ifr- -i to u<wr,• th:d yuulifitA 1-tirs,-l pngxrh ;anther and r,alnate thr inf..rmati.m <br /> .uhmiu,Yl. Ra,rd .,,t mt inyuir', -r the f..r..... ..r lx•rwn. I tnmwur the ...R•tn. <br />? nr tho., Ixr.on. Jimrth n?rwn.ihlr h? L'.tt hrnn•_ Ihr to G.rmati. m. thr in G.rouui.m " %/ - <br />' _ ? <br />l .uhm.n,d n. o, tho Ix.t.d m. hn.,wleder .rud Ixli.•f. true. a.cur.ne. and cnnµdctr. ? <br />I am <br />re <br />,rr Ih <br />it Ihrr <br />,n i <br />nificuul <br />lur, lur .ubmmurX Ld.c infnrnn,tim <br />x <br />SIGNATURE OF PRINCIPAL EXECUTIVE ? %/. ?i .?',J <br />/j '? <br />;may <br />TYPED OR PRINTED . <br />. <br />. <br />. <br />g <br />I <br />na <br />t <br />n.lu.hn;; thr Iw,,,ibdih ..f ?nr and uuprn.mmrni I- I.nneinu %-Iafinn.. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br /> CODE <br />.. v....., a-,?, y r•er?v ?.nr ?r•e,?r. „v,• v. r.r? r •,vLM I rVr?J Ir1 GI GI CIIt.r all dlia" <br />/rclo? °RECIP EVF:N'T SUl <br />t_n 7C 'Elea T?:VT< <br />EPA Form 3320-1 (Rev 199) Previous editions may be used. 0 OO2 j 131tti?iI tr 4-pa" ,kQrm.