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PERMITTEE NAME/ADDRESS (Incllde Faciliry Nmnr/Loca6on ijDi$erenq
<br />NAME CYp"US 15'1oA VA~,L''T ~OAI. C~3P•
<br />ADDRESS~.IIV'?; 1, ]i3 ;nUTH, r; ~C3'!AV pv,
<br />71~U .:4,* '1IV?EAL ~IR~L°
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<br />LOCATION
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR~
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<br />PERMIT NUMBER DISCHARGE NUMBER
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<br />FROM 7'1 ? 7 11 TO n •~ n ~ l
<br />(2621) (2223) (2425) R6-2]) (28-28) (30.71)
<br />Fonn Approved.
<br />OMB No. 2040-0004
<br />M q T `^ Approval expires 0531-98
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E7fAMINEO AND
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<br />' TELEPHONE DATE
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<br />' INOUIIiY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
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<br />COMMENTS'AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
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