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PERMITTEE NAME/ADDRESS Qndude FaciGry NamelLacahon i/Di,((ereny
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<br />NATIONAL POLLIlTAM DISCHARGE EDMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
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<br />Form Approved.
<br />OMB No. 2040-0004
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<br />TYPED OR PRINTED I am aware that (here are slgndicant penalties br submining false informaUOn,
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