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<br />NATId1Al POLLUTANT DISCHARGE EUMINATON SYSTEM INPOESJ ~ ~•~~• /~:~~'-~~! ~I
<br />DISCM1 R6E MONITORING REPORT /OM9/ _ OMB No. 1040-0004.
<br />( Approval etipiree OS-31-98
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<br />YEAR MO DAY YEAR MO DAY __
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<br />NAME/TRLE PRINCIPAL EXECUTIVE OFFICER I CERTFY UNDER PENNTY OF
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<br />TM LAW /NAT 1 HAVE PERSONALLY E%AMINEO AND / - TELEPHONE
<br />AND BASED ON / ~
<br />RMATON SUBMITTED HEREIN DATE
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<br />OBTNNING THE INfORMATION ON
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<br />I BELIEVE THE SUBMITTED INFORMATON IS ~
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<br />PLETE. I AM AWARE THAT THERE APE
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<br />i` I IJP Il THE POSSIBILITY OF FINE AND IMPNSONMENT. SEE 18 U.S.C. 1 1001 AND JG BIONATURE OF VRINgPAL EXECUTIVE -/% '
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<br />COMMENTS AND EXPLANATION OF ANY vtOLA I IUn~ I/Tererenes ai errscnmanQ nere/
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<br />EPA-E'am'3320-T 10 -g5 Previous editions mey ba us ~ (REP CES EPA F~ M T< WNICN MAY N07 BE USED.) PAGE OF
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