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<br />LOCATION___-______ "' ___~__
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<br />NATIONAL POLLUTANT pISCHARGE ELIMINATION SYSTEM INPDES/
<br />DISCHARGE MONITORING REPORT/OM1/R)
<br />11-161 /l7-19/
<br />- PERMIT NUMBER .. ~. a ;DISCHARGE NUMBER
<br />`, ~ MONITORING PERIOD
<br />.':.FROM YEAR Mp 'DAY TO YEAR MO DAY
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<br />NAME/TITLE PRINCIPAL EXECUTIVEOFFICER C'f I I CERTI
<br />`AND AM FY UNDER PENALTY-OFLAW THAT 1 HAVE P
<br />FAMILIAR WRH iHE
<br />INFORMATION SUBMITT ERSONALLY EXAMINED
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<br />ON MY INQUIRY. OF THOSE INDIVIDUALS-IMMEDIATELY •RESPONSIBLE F ~` '., // ^ ~ •': .
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<br />• IS TRUE, ACCURATE AND CAMPLETE::I AM AWARE THATr THERE-ARE SIO~
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<br />COMMEND ND EXPLANATION OF ANY VIOLATIONS /ReJerentt Pllalmrhmenu heir) "' i I ~ '
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<br />OIL e`'GHEASE: SEE YOOTNOTE F/r PAGE 3 OF.TBE PEHtlYT'. POHtlEHLY DISCHABGBC UYDEH.GO-OG35653.__..
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<br />(REPLACES EPA FORM TJO W HICH MAY
<br />GGG11/910123-1657 PAGE ~ of
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