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PERMITTEE NAME/ADDRESS (Include Fan((ry Name/Locadan ifDifferenq
<br />NAME
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<br />LOCATION
<br />NATIIXJAI POLLUTANT DISCHARGE ELIMINATION SYSTEM MFDES)
<br />DISCNARGE MONITORING REPORT (DMR1
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<br />' PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 1 i^, TO ;1 v" ~i
<br />Form Approved.
<br />OMB No. 2040-0004
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<br />41-25J _. i''
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<br />NOTE: ~ Read Instructions before•CDhrpleting this form.
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