PERMITTEE NAME/ADDRESS p.rYd, FslbryNwWlaurm yD~irwq
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<br />NATIONAL POLLUTMT DISCHMOE EIJMINATON SYSTEM INPDES) Form Approved.
<br />DISCHARGE MONRORINO REPORT (OMRI r T V ~ t: OMB No. 2040-0004
<br />I7-161 17-19I
<br />C. O D 9 2115 011 ~ ~ 79 P 5 V) APProval expires 05-31-98
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<br />~ NAMERITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF
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<br />EPA Farm 3320.1 109-961 Previous sdi4om may be used. IREPhACE6 EPA FORM .40 US ..1 Q /1 D R S / ~ a (1 q ? I _ I O Z n PAGE ~ OF
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