Data Summary Form <= Receiving POTW <= Receiving # <= Specific Sample Location! i.e., Give IU Name, IUP#, and/or pipe # Other Other Other Other Lab => MDL => Notes => Conc. Results Conc. Results Conc. Results Conc. Results Conc. Results Conc. Results Sample ID Date Sample or Count Collected from Lab from Lab from Lab from Lab from Lab from Lab <? mg/l <? mg/l <? mg/l <? mg/l <? mg/l <? mg/l 1 2 3 4 5 6 7 8 9 10 11 12 etc TNS => Max. Value => Avg. (use1/2 BDL) =>
Data Summary Form <= Receiving POTW <= Receiving # <= Specific Sample Location! i.e., Give IU Name, IUP#, and/or pipe # Other Other Other Other Lab => MDL => Notes => Sample ID or Count Date Sample Collected Conc. Results from Lab Conc. Results from Lab Conc. Results from Lab Conc. Results from Lab Conc. Results from Lab Conc. Results from Lab <? mg/l <? mg/l <? mg/l <? mg/l <? mg/l <? mg/l 1 2 3 4 5 6 7 8 9 10 11 12 etc TNS => Max. Value => Avg. (use1/2 BDL) =>
Industrial%20Wastewater%20Survey%20&%20IUP%20Permit%20Application%20(Long%20Form).docx