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<br />- Form Approved.
<br />NATIONAL POLLUTANT aSCNAROE ELIMINATION SYSTEM /INPDES/ OMB No. 2040.0004
<br />DISCHARGE MONITORING REPORT /OMR/ B~ ~; (i~Q~
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<br />EXECUTIVE OFFICER t «rtt~y a er peon ty o law Ihu mis daeumem end dl atlnchmenb were TELEPHONE DATE
<br />NAMElI ITLE PRINCIPAL ptepnred under my direction or aupervMon In neeord~nn with a system deal`ned ~
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<br />TIVE ~U ~~~_ y~G~
<br />~'~ A/f ~ ~~ i nm aware Nnt there ore slEnifluM penalties for submlltin~ hbe Inrormntlon, EIONATVRE OF PRINCIPAL EXECU
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<br />ORIZED AOENT A A
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<br />TYPED OR PRINTED Inctudln` the possibility orOne and ImprNonment for kstowlnt vldatiom. H
<br />OFFICER OR AU CODE
<br />COMMENTS AND EXPLANATION yr nor vwu~- t tvrta /istrrtrr~nctr wi .a.c,or,.r.w rr.r.,
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<br />4?Q1C)~i/O~-,~~J~`~"p4~• PAGE ~OF
<br />EPA Form 3320.1 (Rev. 3/99) Previous editions maybe used.
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