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PERMITTEE NAME/ADDRESS ((ncludc Fanlin ~Vame/Lncarion r/D~e.enll NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTQM (NPDE3) Furm Approved. ~ +
<br />NAME DISCHARGE MONITORING REPORT (OMR; OMB No. 2040-0004 ,
<br />ri I H F EC ~ I >+C • Iz-16> {,a 91 C l N L F Approval expires 05-3( 98 1,
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<br />2764 COCPASS~ G6.IOE, $DITE 'I02 PERMIT NUMBER "~- Dlsc '~ u ~~R F _ FII~ZI' ~ ° FIY'~E`
<br />FACILITY GRA ND JU YCTICl4 CO 82SD6 '.~.r MOR(TO,RING PERIOD ~ :~~;, ~ CH RO RI '-~ IT 2ES1,I l'~6qq FCF CC711
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<br />t. A H BO N D A L E CO E 16 2 3 FROM `TO U 0 ., ead Instryctions before completing this form.
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<br /> ` (3 Cercl Omy) QUANTITY OR LOADING' (4 CBN Only) QUANTITY OR-CQ TION NO. FREOUENC SAMPLE
<br />PARAMETER (4s-53) (54-6f) (3B-45J (46-53)',' (54-6r) EX OF TYPE
<br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAG MAXIMUM UNITS
<br />Isa ral ANALYSIS
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<br />69-70
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