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<br />NATIONAL POLLUTMT DISCHMOE ELIMINATION SYSTEM NPDESI
<br />DISCHARGE MONITORING REPORT !D Rl
<br />11-16I (17-191
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<br />PERMIT NUMBER DISCHMGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM `I t'C TO ''" - "
<br />114111 /11-231 114151 /16171 /1g-19/ !34311
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<br />Form Approvetl.
<br />+• n OMBtNo~ 2040-0004..• .
<br />Approve, szpires OS-31-98
<br />NOTE.' Read inetructiaru before o •plerinp this form-
<br />PARAMETER 13 Card Onlvl QUANTITY OR LOADING !I Grd Onlvl OUANTITY OR CONCENTRATION NO• mEDUENCr SAMPLE
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<br /> MEASUREMENT
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<br />itiekard .' Ille• MT INOUIRV OF THOSE INDINOUALS IMMEDIATELY RESPONSIBLE FOR
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<br />' SIGNATURE OF PRINCIPAL E%ECUTNE
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<br />EPA Form 3]20.1 108.951 Previous edl[lons mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) ^ ^ ^ c , / n ~~ r ~ _, ~ PAGE ) OF
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