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P[IISIPTTlC NAMElADDR[fB (/ncludl <br />F~c!liry Name/Locrrbn iJdiJJnrnl/ <br />MAM[_Cl['nJ_~ Y91_`Irk r-Li ,-7 .:Usi. ~.:%Fe.__ <br />ADDq[p'1_h=J ljL CG ? : L~~ i : !~ ( _._i=l! r X -_ <br />-wuurT_______ _-___ <br />LOCATION <br />w wTloR wL PoL LUr Aryl olscN wwoE CLIN INwr1oN sYSr[M (NPDES) <br />DISCXARGE MONITORING REPORT /DMR) <br />l l6 1~ <br />;:u,:;;c71~4 CvI , <br />PERMIT NVMB[R Rrscn.wos nur.[w <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM sU .. ~.. TO ~ ~ „_ ~ r <br />rzavl az.zJl al.zsl nA. vl na.~m ran. r/r <br />'~ "' `7 i' " Form Approved. <br />(.9 ~ i' k t: ~a) OMB~No.+2040-0004. <br />r- k ~ '+ Y L Approval expires 6-30-91. <br />:l r': tr Fi.:ri 1J k',:.::i.L Chi; <br />NOTE: Reed instructions before comDletinD this form. <br /> (J Catd Only) OU ANTITY OR LOADING (1 Card Only) OU ALITY OR CONCENTRATION <br /> <br />PARAMETER <br />(16-33) (SIfi!) <br />(J8~7) (1653) (JIfiJ) <br />NO. 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