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<br />PERMITTEE NAME/ADDRESS (/nelude Faniiry NameA.acaNon /fLNBerenr) NATONALrTOLLUTANf DISCHARGE ELIMINATION SYSTEM (NPDES) Form ApprOVed. j
<br />NAME D(SCHARGE MONITORING REPORT (DMR) OMB NO. 2040-0004 '
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<br />LOCATION YEAR MO DAY YEAR MO DAY • __
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<br />COMMENTS AND EXPLANATION.OF ANY VIOLATIONS (Re/erence all attachments hem)
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