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PERMITTEE NAME/ADDRESS (include Facilip• NamdLoradon fDige.enQ
<br />NAME
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<br />ADDRESSU : g g I, : ~, U ry I (; "
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<br />FACILITY N %I N ., L T J] rt i o u?
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />^nf fl :1 (17;t ! S
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM J 1 C 1 ~I 1 TO u l ~ 1 3 I
<br />Fonn Approved.
<br />OMB No. 2040-0004
<br />"!INOR
<br />F - 'I. `IAC
<br />?F-L 1.7A[-CUT
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<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
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<br /> MEASUREMENT
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