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<br />NATIONAL POLLIfTANT DISCHARGE EUMINATON SYSTEM (NPDES)
<br />DISCHARGE MONRORING REPORT (DMR~
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<br />PERMIT NUMBER DISCHARGE NUMBER
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<br />Form Approved.
<br />_ _ OMB No. 2040-0004
<br />"' ' ' ' Approval expires 05-31-98
<br />. NOTE: Read Instructions beforezorripleling this form.
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF l
<br />AM FAMILIAR WITH THE INFORM AW THAT I HAVE PERSONALLY E%AMINED AND
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Hererence an ertacnments Here)
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<br />EPA Form 3320.7 (OB-95) Previous editions may not be used. (REPLACES EPA FORM T~0 WHICH MAY NO7 BE USED.) PAGE OF
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