PERMITTEE NAME/ADDRESS (include Facility Nanle/Lncalion i/Diperen(f
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<br />NATIONAL POLLUTANT DISCHARGE EUMINATON SYSTEM (NPDESJ
<br />DISCHARGE MONITORING REPORT (DMRJ
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM i.)U 111 C? 1 TO i?(i i '-` ::i 1
<br />Form Approved.
<br />OMB No. 2040-0004
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