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<br />LOCATION -----.-
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<br />N ATIONwL FO LLV TANT OIICNwgGE CLIM IN ATION EYST[M /NPDESI
<br />DISCHARGE MONSTORING REPORT /DMR)
<br />1•/6 1119
<br />.: ._.I: _.I _
<br />` PERMIT NUMDtR Dlsc NwwRE eoMwrw
<br />MONITORING PERIOD
<br />YEAq MO DAY YEAq MO DAY
<br />FROM p - L .. .- TO : ~ .
<br />I18~111 /11131 /11~1L 116 71 118191 /30-311
<br />Form Approved.
<br />i `` `' ~ ') OMBINo.2040-0004.
<br />- . , . L Approval expires 6.30-91.
<br />. _ F • ~. . -_ ... .~f•
<br />NOTE: Raad instructions hefors completing this form. _
<br /> (! Card Only) DUANTITY Oq LOADING (1 Card Only) OU ALITY OR CONCENTRATION FR EOU ErvcY gAMPLE
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<br />E% of TYPE
<br />(.)1-37) wN xL V515
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<br />NAME/TITLE PRINCIPAL EX[CUTIYE OFFICER I OERTIFr UNDER PENALTY OF LAw TNAT
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<br />AND AM FAMILIAp MTH THE INFORMATION SUBMITTED NERCIN AND BASED
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