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<br />FACILITY
<br />LOCATION
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SY9TEM INPOf$l
<br />DISCHARGE MONITORING REPORT IOMRI
<br />l7-I5I 117-191
<br />"l~~?715Ct '11 "' B
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM '~7 lij '_' TO n^, ')7 T1
<br />02Jr1 OJJiI tlLJ51 OR.J)I ORJGI /+2321
<br /> Form Approved.
<br />. r ..• ~ - -~.~ -. F ^'rTOMBrNo. 2040-0004
<br />, , _ ~ e~Cpires OS-31-98
<br />Approval
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<br />NAMEITITLE PRINCIPAL EXECUTNE OFFICER I CERT
<br />AM FA FY UNDER PENN.TY OF LAW THAT I NAVE PERSOMN.Lr E%AMINEO AND
<br />MILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON TELEPHONE DATE
<br />' MY INOUIRr OF TNOSE INDINDUALS IMMEDIATELY RESPONSIBLE FOR /f
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<br />OBTNNING THE INFORMATON, I BDJEVE THE SUBMITTED INFORMATION 19 ~ , ~ j~
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<br />Environs^erltal lAanaoer TRUE. ACCURATE AND COM0.ETE. I AM AWARE TNAT THERE ARE
<br />SIGNINCANT PENALTIES FOR SUBMITTING FALSE INFORMATION
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<br />THE POSSIBILITY OF FNE AND IMPRISONMENT. SEE 18 U.S.C. 1 1001 AND 93
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<br />EPA Form 3320.1 106.95) Pravlous edltlons mey be used. n / (REPLACES EPA FORM T-40 WHICH MAY HOT BE USED.1 r r ~ r T / ~ n t` /I ~,/ _ ~ ~ ~ r PAGE OF
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