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<br />PERMITTEENAME/ADDRESS(Indude Facility MvnrlLacafion ~Dijl4renq NA~JONAL POLLIJrANT DISCHARGE ELIMINATION SYSTEM (NPDES) - FDrm ApprOVed.
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<br />~ .r, DISCHARGE MONITORING REPORT (OMR) OMB NO. 2040-0004
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<br />ADDRESSTR~I PPER PANE ~ ~'
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<br />PERMIT NUMBER DISCHARGE NUMBER
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<br />FACILITY ., R-I6. CJ 8162 MONITORING PERIOD DISCNRG TO P1:9 dE,:.GULCN ~ ,-
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<br />~` A orm 33 ) tavto se II may a se ~ ° '. ~^~~, ,__ ry_ THIS ISA~-PART FORM PAGE nF
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