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f'EflMIfTEE NAME(AOORESS Pu4rb f.rWy NadLocanu I/D(Qfsw1
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<br />NATIONAL POLLUTANT DISCHMOE LIJMINATION SYSTEM INPDE$l
<br />DISCHARGE MONfTORING REPORT IDMRI
<br />/1-16I /17-741
<br />PERMIT NUMBER DISCHARGE HUMBFR
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<br />YEAR MO DAY YEAR MO DAY
<br />FROM f .I ~ ~ L' TO ~
<br />!26711 !?I-731 124151 /26771 (28-241 1363f1
<br />Forrn APProved.
<br />G i i; -' i ;• ~: L .: ~' [ OMB No: 2040-0004
<br />~ : , ~ ` ~ , I) Approvd expires OS-31-S
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<br />NAMEli1TLE PRINCIPAL EXECUTIVE OFFlCER I cERnrv IrrrDEn PENALTr oFL
<br />AM FAMWM WITH THE INFO ww TNAT I RAN: PwsoNAUV E1IAMINEO AND
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<br />MY INOUIIY OF THOSE INDINDVALS IMMEDIAT0.V RESPONSIBLE FOR
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<br />SIGNIRCANT PENALTES fOR 6UBMITTINO FALSE INFORMATION
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