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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different)
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<br />Form Approved.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) OMB No. 2040-0004
<br />DISCHARGE MONITORING REPORT (D R) ;,~ -^ ; ~ _,.a
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<br />PERMIT NUMBER DISCHARGE NUMBER •- -q"= ? j;i;:}~ 1 •r L p 1.3 i~4-~6°}
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<br />MONITORING PERIOD
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<br />NOTE: Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY
<br />OF SAMPLE
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER 1 cerfify under penalty of law that [his document and all attachments were
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