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<br />NAME DISCHARGE MONITORING REPORT (OMR;
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<br />Form Approved.
<br />OMB No. 2040-0004
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<br />NAME(fITLE PRINCIPAL E%ECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND TELEPHONE ~ DATE
<br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN. AND BASED ON MY ,
<br /> INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING `
<br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE: ~
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<br /> ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT / `
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<br />~~ ~(/ P1 G , l PENALTIES FOR SUDMITTING FALSE INFORMATION, INCLUDING THE
<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. § 1001 AND 33 U.S.C'
<br />SIGNATURE OF PRINCIPAL EXECUTIVE ,l
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<br />TYPED OR PRINTED § 1319 (Penalties under Nose stables may inclutle lures up ro E10,000 antl w
<br />rtresimum impnsonmenl of OeOVeen6nronlhs ends years.) YOFFICER OR AUTHORIZED AGENT ~`
<br />CODE NUMBER;'-. .YEAR 'MO DAY
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<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) ~ ~ . ~ ... ~ ~ ~ • `~ ~ '
<br />SE;TTLEARLE' SOLIDS LIf!IT APPLi°S OSLY IF <=lUYii,24HR PRECj~P:6~i~Y'.~15 CLAMS"D. IF CL~1Il4.+E~:~~dp1?D E~ W~CU,
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