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Form Approved. <br />PERMITTEE NAME/ADDRESS rlndud~ facility VamelL~ktui~n if Aifferenh NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) OMB NO. 2040-0004 <br />NAME DISCHARGE MONRORING REPORT (DA4R) <br />ADDRESS _ J~ <br />PERMIT NUMBER DISCHARGE NUMBER ' f'INL_ - <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ , <br /> MEASUREMENT ~- <br /> P <br /> ERMIT <br />REQUIREMENT <br /> SAMPLE <br />~ <br />' <br /> MEASUREMENT i - <br /> PERMIT <br /> REQUIREMENT `- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />1 r <br /> MEASUREMENT ~ ~/ <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT `, - <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT - i <br /> PERMIT ~ ~ <br />~ <br /> REQUIREMENT _ <br />J ~ -• f~ <br /> SAMPLE ._. <br />- 1 ~ <br /> MEASUREMENT - <br /> PERMIT ~- ' • <br /> REQUIREMENT <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I certin under pettett} onaw that thi+d~wutncnt and all aunahment, were <br />d <br />l TELEPHONE DATE <br /> e,igmv <br />prepared under m~ direction or wl>. ra i+inn in acnrrdamr with a +~+tem <br /> In a+wvc That yualifitd prr+nnnel propr tl~ gather and eraluate the infurmatiun j <br /> wbmiurd. Maud on m. inywn of thv prrvm ur prnon+ who manage the +~+tem. <br /> ar tho+e prnan+ dincllc mpm+ihlr roe gathering the infornwUon, the information ~ ' <br /> and com <br />to the hr+t ..f m. 6m~oled <br />e and tudief <br />tnre <br />:ururatc <br />lete <br />h <br />iu <br />d h ~ I <br /> . <br />g <br />. <br />. <br />. <br />p <br />w <br />m <br />a <br />, SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> <br />TYPED OR PRINTED I am aware that tlw•re :u+~ ~~ini~c:mt pomAUr+ for ~nhnutting lulu inlormutirw. <br />im'luding the Iw++ihifih of Iln.:uiA imps+~mmcnt 6.r Avowing +i~dnlinrt+. FICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) I <br />~4HP f'P.FCIP EVF <br />D ~t <br />~. <br />EPA FOrm 3320.1 IRe.~ _ ?4. Pre.v~.:u> .-;,+,,, ~ r i.e ~,sec1 I hip I~ a -.-had; li,l tTl PAGE OF <br />