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PERMITTEE NAME/ADDRESS (Include Fanliry Name/Cacafion iJDi$erent)
<br />NAME
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<br />ADDRESSl1~SEud'J :I "I9l;
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<br />FACILITY I. n J' L 1 ~.~ :~ i't i
<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM MPDES)
<br />DISCHARGE MONITORING REPORT (DMRJ
<br />"1^U7Hfl') n
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM 1 O I 1 TO ' 1 U 1. 11
<br />Form Approved.
<br />OMB No. 2040-0004
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<br />F' - F1`:AL
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<br />NOTE: Read Instructions beforeZSfnpleting this form.
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<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER EX of TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANACrsIs
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<br /> MEASUREMENT
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<br /> MEASUREMENT
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