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<br />NATIONAL POLLUTANT DIBCHMOE ELIMINATION eYBTD.I /IIVPDE$l
<br />DISCHARGE MONITORING REPORT /DMRI
<br />12-18 17-791
<br />PERMIT NUMBER DIBCHMOE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAV YEAR MO DAV
<br />FROM ~ Uti ul TO yy 4,p ~;I
<br />!2421/ I12-2J1 111-151 !16771 12B-29I 1J431/
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<br />Form Approved. ~ .
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI FY UXOER PENALTY OF I.AW THAT I HAVE PERSONKLY E%AMINED IND TELEPHONE T
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<br />OBTNNING THE INFORMATION, I BELIEVE THE BUBMIT1 iD INFORMATION IB
<br />TflUE, ACCUMTE AND COMRETE. 1 AM AWARE .TNAT THERE APE
<br />BIGNIRGANT PENALTIES FOR SUBMITTING FALSE INFORMATION
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