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<br />FACILITY
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<br />NATIONAL POLLUTANT DISCHMGE FLIMINATON SYSTEM INPDES)
<br />DISCHARGE MONITORING REPORT lOMRI
<br />11-191 l17-191
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<br />PERMIT NUMBER DISCHMGE NUMBER
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<br />YEAR MO DAV YEAR MO DAY
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<br />!14111 l11-131 III-151 116771 l18-191 !30311
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<br />T~ r.OMB)Noa 2040-0004c v
<br />Approval elrpires OS-31-98
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINW AND TELEPHONE GATE
<br /> AM FAMILIM YNTH THE INFORMATION SUBMITTED HEREIN; MD BASED ON
<br /> MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR / / ~ /
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<br />EPA Form 3320.1 108.951 Previous editions may be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 ,I n ~ ~ 1 / ~ ' ,'14 n ~ _ T n 7 ~ PAGE , OF
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