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PERMITTEE NAME/ADDRESS(IaatrlriaeRlryNwr/LoeatenljD(Qirsnr)
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<br />NATIONAL POLLUTANT DtSCMAROE ELIMINATION SrSTEM //NPOESI
<br />DISCHARGE MONITORING REPORT /OMRI
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<br />PERMIT NUMBER DISCHMOE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO OAY
<br />FROM C71 i c tJ'1 TO C1._ ~ ~
<br />Form Approved.
<br />OMB No. 2040-0004
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<br />TITLE PRINCIPAL EXECUTIVE OFFICER
<br />E ' ""'ty ° of a", ty o i.o that thb aoeumenLSnd eu rrttrrdtmenb were TELEPHONE DATE
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<br />SPED OR PRINTED Inclualn` the possibility or Brae and Imprisonment for knowinE .idalloin OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Refirenci M/ ett~chments hard
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions ma be used. ~~}1$ IS 8, 4 P81x, OT/tl. PAGE ~OF
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