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I'ERMITTEE NAME/ADDRESS pneriinNbyNwJLnralan UDIL1GrwrQ
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<br />NATIONK PoLLUTANT DISCNMOE ELIMINATION SYBTEM INPDfS1
<br />DISCHARGE MONITO T M
<br />Form APProved.
<br />OMB No. 2040.0004
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<br />PERMIT NUMBER DISCNMOE NINAtlER - ,( .;. Y, ttiN :.+L a1 i/
<br />MONITORINGPERI00 i"-= a,f7s"Lf:+M11.'':; ?`~ -,~?:;_~~ >`~;sii
<br />YEAR MO DAV YEAR MO, DAV ''yy
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<br />QUANTITY OR LOADING
<br />AVERAGE MAXIMUM
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFlCER
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<br />TELEPHONE
<br />` -~'"/ Inm nwnrt Dal lhert.rt YtNRnM pmtltln terwhmlltlnt Ohx lnhrmtlon. 6IONATUIIE OF MINCIPAL EXECUTIVE
<br />TYPED OR PRINTED InchMLq lM pmtlhNy orRnenM lmplbwlmml rorLmwln[HNnamn I OFflCER OR AUTHORIZED AOEM A A NUMSER4
<br />CODE
<br />:OMMENTS AND EXPLANATION OF ANV VIOLATIONS lRdnencr ~//AftachmAnts hpr~l
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<br />PA Form 3320.7 (Rev.3/99) Previous adifions may he used.
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