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<br />NATIONAL PoLLUTANT DISCNMOE ELIMINATON SYSTEM (NPDESI Form Approved.
<br />DISCHARGE MONITORING REPORT IDMRI MB No. 200-0004
<br />12-161 17-191 ~ '
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM A FY UNDER PENALTY OF UW TNA71 NAVE pEflsoNN.Lr ExAMINED ,wD
<br />MIUM WITH THE IN . RMATION SUBMITTED HEREIN; AND EASED ON
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<br />MY INOIIIRY OF TNOSE INDIVIDUALS UAMEOIATELY RESPONApLE FOfl
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<br />OeTNNING. THE INFORMATION, 1 BFUEVE TyE SUBMITTED INfORMATION IS
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<br />SIONIpCANT PENALTIES FOR SUBMITTINGFALSE INFORMATION, INCLUDING
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<br />'J73('!?Y THE POSSIBILITY OF RNE AND MIFRISONMENT. SEE to LLS.C.11001 AND @3 ~ - '/'%n .,~~(I_' ~~ ~. ~- ,
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<br />TYPEDORPRINTED sra wmuhs.n irrprlaelrrt elerfvwn smmN, rH6r.esl OFFlq:R OR AUTHORIZED AGENT CODE NUMBER
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<br />EPA Form 3320.1 108-95) Previous editions may ba used. (REPLACES EPA FORM TAO '~"'.ICH MAY NOT BE USED.) PAGE OF
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