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<br />LOCATION _______ ________
<br />D1'THe RT.^41 An !: r/TY 7T: :!1 !:
<br />HwnoHwL roLwTw cYwwc[EUYrNwnoH •vsr[M INFOESI
<br />D ISCNARC~NITORIHG REPORT /OMRI
<br />116 17-lfl
<br />-ERMIT NUMw[R m[c r.Anc[ HuMF[n
<br />MONITORING PERIOD
<br />YEAR MO pAV YEAR MO pwV
<br />FROM I ~.,) I- TO I'1 J 1 _ ..
<br />raoal/ Haul u1.as) 116-11 !18791 ! a u
<br />A; T t~ 0 y Form Approved'
<br />(~ I I n ;( 'I u) n, OMe TFFo. soao-oooa
<br />F - F'I t:AL Explra0 9.30.91
<br />L'1 n.^011'f 1.~OI' :,EDT/aIl.::i')N `"I'r.r.P•
<br />NOTE: Ratl imtruetiom Mfora mpletinp thi! form_
<br /> (3 Cerd Only) QUANTITY OR LOAOINO (1 Cerd Only) QUALITY OR CONCENTRATION fwEOU[NC•
<br />BAMPLE
<br />PARAMET[R (IL-73) (31fi1) (J8A!) (16-0J) (71fi1) HO.
<br />Elf OF TYPE
<br />(81'17) AV ERAOE MA%IMUM UNITB MINIMUM AVERAGE MA%IMUM UNITE
<br />6143) wNwLVals
<br />(6168)
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<br />PR BAMPLE Ii :tY,', N:Ir. fFl:r;:N:;:::t ( ) :::f,::''~I(F ( 12)
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