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PERMITTEE NAME/ADDRESS (Inelude FocRlty NmnrllaeNOn yDif(erenq
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<br />LOCATION
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<br />NATONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMRJ
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM ,ri lJ '; ? TO .i,, j •.~
<br />Forth Approved.
<br />OMB No. 2040-0004
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<br />,NOTE: Read Instructions beforl 6m'pleting this form.
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<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
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<br />COMMENTS AND F~(PLANATION OF ANY VIOLATIONS (Reference all attachments here)
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<br />EPA Form 332a ( 9) revtous itioris may a used. ~ - ` ` ' ' ° ' " ` "" _ .I j _ 1 / ~ TriIS IS A 4-PART FORM PAGE 1 OF
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