Industrial Wastewater Discharge Monitoring Form
Company Name
Facility Address
Date
Report Prepared By
Discharge Details
Monitoring Point
Discharge Start Time
Discharge End Time
Total Discharge Volume (m³)
Sample Information
Sample Type
Grab
Composite
Sample Date & Time
Sampler Name
Analytical Results
Parameter
Result
Unit
Standard Limit
Chemical Oxygen Demand (COD)
mg/L
Biochemical Oxygen Demand (BOD)
mg/L
Total Suspended Solids (TSS)
mg/L
pH
Oil & Grease
mg/L
Total Nitrogen
mg/L
Total Phosphorus
mg/L
Other (specify)
Remarks / Actions Taken