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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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<br />NOTE: Read Instructions before completing this form.
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<br />' TYPED OR PRINTED I em aware that Nero ere elgnlllrarlt panetew br aubmlping talsa bNOrmetlon,
<br />Includl Na blli of lNe and lm necnment br lurowln vloleaorla. OFFCER OR AUTHORED AGENT
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