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<br />NATIONAL POLLUTMT DISCHMGE ELIMINATION SYSTEM lNPDES)
<br />DISCHARGE MONITORING REPORT lOMRI
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<br />PERMIT NUMBER DISCHMGE NUMBER
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<br />YEAR MO DAY YEAR MO DAV
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<br />17671/ l77-731 l24-751 /16771 128-191 136311
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<br />Form Approved.
<br />-.--OMB.No. 2Q40-000,4Q 1•
<br />Approve(expilPa 05-31-98
<br />NOTE: Reed inetruetlom before complatinp this form.
<br />PARAMETER !3 Card Only1 QUANTITY OR LOADING !4 GYd only/ QUANTITY OR CONCENTRATION NO FREQUENCY SAMPLE
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<br />NAME/TITLE PRINCIPAL EXECUiNE OFFICER I CERDFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED MD
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