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I[RMITT[[ NAM[/ADDp [!f //ANudf <br />F~rQlfy NDne/Lonrbn IJdIJJn[nq <br />JLS_1:.LLL~'A]'n ii131~=~"'.~1iY------- <br />ADD~[nrnt luT~~~____ <br />---5.7_3..1~~T9_T..~'t.LG~' Y~_ll------ <br />---.nE~-"~--------~:SL 31 ~ 4l- <br />~waurv ---------------- <br />LOCATION _______ <br />Aff!ls Rt.'IIAk~ 1: A7K7):~f)N <br />NwTIONwI. POLLUTANT D19CNIIRGC [LIM INATIQN 9Y9I[M 1/.!r/L J/ <br />DISCHARGE MONITORING REPORT rDMRI <br />7 l6 17-19 <br />Lr <br />IERMIT NUM~[R Ruc HAwcr wRM•[A <br />MONITORING PERIOD <br />YEAp MO DAY YFAR MO OAV <br />FROM 1; TO ~~ / <br />/1011/ /11~1J1 l11~1S1 /16~ I /18191 / 0. Il <br />M ]; ~' (1 (? Form Approved <br />( `; 1! f+ Fi !! W) 11'OMf3'fNo. 2040-0004 <br />F' - F' I !~ J! L E%plres 9.30.97 <br />I'f?(.':iPECT SED PU/GURU SPF+1 v': I <br />NOTE: Rafd instruLtfonf fx}ors ` mpl[Unp This form. <br /> (J Card Only) QUANTITY OR LOADING (~ Curd Dnly) OV ALITY OR CONCENTRATION rR[OUFHCr <br />PARAMlT[R (16-7J) (7141) (Jfa3) (16JJ) (~~!) 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