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<br />NATIONAL PO LLVTA MT DIlCN LARGE [LIM INATION IYSTEM /NiDE51
<br />DISCNARGE MONITORING REPORT /OMRI
<br />1-16 j7-I9
<br />' PERMIT NUM RlR orscH.wcF NUMREw
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<br />YEAR MO DAY YEAR MO DAY
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<br />' Form Approved.
<br />i OMB'No:2040-0004.
<br />-- '_ Approval expires 6-30.91.
<br />NOTE: Resd instructions bafor- a completing this form.
<br /> () CRrd Only) qU ANTITY OR LOADIND (1 Card Only) OU ALITY OR CONCENTRATION Fq EOU ENCv
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<br />NAME/TITLE PRINCIPAL E%[C UTIVE OFFICER OF LAw THAT I HAVE PERlONALLr EXAMINED
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