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<br />NATIONAL FOLLV TANT DISCN ARC[ [LIM INATION [•'[T[M (NPDESI
<br />DISCHARGE MONITORING REPORT /DMRI
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<br />PERMIT NUMBER Rlac.nwc[ rvuM[[w
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ~ _ _- TO ,.
<br />/10~2b /11131 /14~IS1 /I6-171 118:9/ 130.311
<br />Form Approved.
<br />~ ' ~ OMB No. 2040-0004.
<br />- _ .: i Approval expires 6-30.91.
<br />,. _ - K
<br />NOTE: Reed instructions tafore completing this form.
<br />•~ (3 Card Only) QUANTITY OR LOADING (I Card Only) QUALITY OR CONCENTRATION FREOUEncr BAMPLE
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<br />NAME/TITLE PRINCIPAL E%[C UTIVE OFFICER I CERTIFY
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<br />o•d••r narrnl.m rnrprlnrurnlrnr,.l F.rur.nfimunlh. and.i •rar..r OFFICER OR AUTMORIZEO AGENT A A NUMBER YEAR MO DAY
<br />eCIMMenI Anp E%pLANATION OF ANY VIOLATIONg 1/(r)rren~r all almanmtmt nert)
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