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<br />N IITIONwL FO LLUTwMT OISCN/1gG[ ELIMIN NTION SYSTLM /NPDESI
<br />D ISCMARGE MONITORING REPORT /OMRI
<br />'1-16 17-l9
<br />/. i.i 1-~11 U4.i it
<br />r PERMIT NUMBER ol.cx AwcF xVMFEw
<br />MONITORING PERIOD
<br />YEAR MO OAY YEAR MO DAY
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<br />110~1/1 /11~IJ1 /Id.1J1 /76171 /18.191 /30.3/1
<br />ri J C . Form Approved.
<br />~ ~~ % ~ ~) OMBINo.~2040-0004.
<br />t - r 1 '; a: Approval expires 630-91.
<br />NOTE: Read instructions bsfore epmpletinB this form.
<br /> (3 Card Only) QUANTITY OR LOADING (d Card Only) QUALITY OR CONCENTRATION FREOUEnCr
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<br /> OBTAINING THE INFORMATrO" I BELIEVE THE SUBMITTED INFORMATION '
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<br />TYPED OR PRINTED e•dr..ma.rnruni rnrynnurnrrnl n/Arlvrrnfim..nlA. andi•rvr•r OFFICER OR AUTHORIZED AGENT GR~A NUMBER YEAR MO DAY
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