P[RMITT[E NAMEIAODREee (InClud[
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<br />n wrlDHwL ro LLUrw NT D1scNwwGF FLIMInwTlon srsr[M INPDESI
<br />DISCHARGE MONITORING REPORT /DMRI
<br />1-/b (7-( fl
<br />PERMIT HUMBER o1.<HwncE n1IM.eR
<br />- MONITORING PERIOD
<br />YFAR MO DAY YEAR MO OAY
<br />FROM ~ G . TO 9B 03 31
<br />170J 1I /?1J 41 /llJb lJ6J ]I /JR.?OI /40.311
<br />N I ^. U ,. Form Approved. ~
<br />(S U b d Y C ~MBftlpY 2040-0004. '
<br />F - t'1 NALApproval expires 6-30-91. ~
<br />FOST-f"INING AUNOFF''77""~y~S77..EDI PO:+D ,
<br />NOTE: Rasd~instructlonR before EBTplet ng hie form.
<br /> (3 Card Only) OU ANTITY OR LOADING (I Card Only) QUALITY OR CONCENTRATION FREOU FNCr
<br />BAMPLE
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<br />ED HCREIN AND BASED
<br />ON MY INQUIRY OF TN05E INdVIDUALS IMMEDIATELY RESPONSIBLE FOP
<br />OBTUNING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION
<br />G„ IS TPUE ACCURATE AND CCMrRLETE I AM AWARC THAT TH[RE ARC SIG y
<br /> NIf ICl1NT PEN1LT25 FOR $UBMITrING FwLSE INEORYATICN 1NCLUOING L ~
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<br />COMMENT ANO EAPLANATION OF ANY VIOLATIONS (ne/oPnCF ul1 ulwrnm(nre n[FE/
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<br />SETTL£A6LE SOLIDS LIMIT MILL BE YAIVED FUR >1J-Yh, L4-Rfi 1~dECIP EVENT-SEE I.A.:., PG IV, FOE PF.IJIRSt.EFTS.
<br />(iF(PhLY SAMPLING INSTRUCTIGNS-I.C.9, FG IX. ,3G DAY AYG IS MiVHEST MONTHLY AVG DURING PEF.IOL R?PUK':ED.
<br />EPA Form 3320.1 (Rw. iF88) Prwhue editions maybe used.
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