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PERMITTEE NAME/ADDRESSrhtrledr Furilin \mnr/l,nofi,ru i/!rr//rrerN! <br />NAME <br />ADDRESS <br />. •'IA <br />FACILITY <br />LOCATION <br />I F\ ' <br />Ti P F=AR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No 2040.0004 <br />MINOR <br />r `?UPF•' MH <br />F - FINAL rDELTA <br />TrD N F'PA OF Gk.;Niti 19!71N RV <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :.,. :•. .¢ fi X _ r"- <br /> REQUIREMENT <br /> SAMPLE r ?t <: r i <br /> MEASUREMENT ' <br /> PERMIT 'r:r <br /> REQUIREMENT }i !^s 1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT tie # •, i' # r . F ?i i C E:` : R.<+IS <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t:r. s , -? #3f?1 CJ ?Fr?_: <br />I ;j; REQUIREMENT <br /> SAMPLE :. <br /> MEASUREMENT <br /> PERMIT F, Of' T P?: -A >t + p r i h r: <br /> REQUIREMENT c,tJ;; <br /> SAMPLE } - < x <br /> <br /> MEASUREMENT <br /> PERMIT t :4 It ? t, w.rJ; <br /> <br /> REQUIREMENT <br /> SAMPLE , <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I -rtir) "nder I"'natty nl IJ Ihw mr. d.ruunaU and all I -cm <br />r <br />n dir <br />+ith a - <br />'d und <br />d <br />r <br />rsd <br />• <br />i <br />d <br />- TELEPHONE DATE <br />T <br />P pan <br />r <br />n <br />ernnn - %np-nwn <br />n acenr <br />un- + <br />i,rn <br />e. <br />pn <br />a <br />In a-n- IhJI qualorml I.-r-nno In-I.. 1, ,.,t hrr and r•Jlu.dr tln? rnr,rrm.rtim. ,-, <br />- j ,•? <br />_ <br />) <br />it i ni,nnti 1. R-rd nn my ingtnr+ .d the I"rvar nr wr.un, nhn numag, the -te"t. <br />/ <br /> ..r tb..v r"'nun. din•dly r rpm.drte fur _alherinL• Ihr inr-nwli.rn. the inlet mJtiun <br /> "d i1i'A i, h. the I"nt .d m+ ArraNledCr Jtrd Ikhel, IrnP.:hrnrJll'. and ...rnpleu. <br />fd <br />?u <br />d <br />•r <br />w <br />•n <br />I <br />b <br />unur <br />f <br />d <br />', <br />d <br />t <br />i <br />d <br />h SIGNATUF?E OF PRINCIPAL E%ECUTIVE . <br /> , <br />r. <br />r are - <br />r" <br />a <br />n, <br />nr n <br />n <br />: <br />.r <br />i <br />n <br />i <br />n <br />¢n <br />i- <br />C OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED Indin m.' pn..ihiht> of finr and unprhnnmrnl fur Ann++in +i..laG.m,. CODE NUMBER YEAR MO DAY <br />COMMEN15 ANU LXNLANAIIUN UF- ANY VIULAIIUNS (rrererence all arracnmenrs nere) <br />:ECIP EVENT SUEJE:CT TO BURDE-N OF PROOF REQUIREMENTS IN <br />t.j O TO THE DIVISION WITHIN r° F'.OI..PS. <br /> <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used ??? LLr1 -I-his- TY T •S-p trt -, grni.