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PERMITTEE NAME/ADDRESSnwdrifrWryNrrL,e,nen~/P.~'ire"r) NATIONAL POLLUTANT aSCHMOE [IIMINATION SYSTEM /NPDES/ F:'r' Apprc.ea
<br />NAME DISCHARGE MONITORING REPORT IDMRI OMB No 2040-0004
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' ""'+r " oe"• t r ° ^w IhN NN docomrnt ,nd ,n ,tt.chrrrntc .ere
<br />TELEPHONE
<br />DATE
<br />PRP,RJ "nAcr T) OI"Kllon or fupen'Mon In ,ccord,ntt wllh , cJelenr ddtned
<br />to ,sure tAN 1"^Mfled penonnN yroptAr t,IMr ,nd cc,lu,lc IM Inrnrm,lbn
<br />sahmlttad. e.,ee en rnr Inquiry o! the pveon or pengp who m,nge the er^tem,
<br />or tAo^e penerr dl rerllr re^oetdbk for plheAnt the Inform,tlow, the Inrorm,tbn
<br />whm+lled b. b the he,t o/ my knowte6te ,nd hexer, Iroe, tlnvrlle. ,nd tornMelt. -
<br />r ,rn ^w,re u,t mere .re eltdfk,nt Fen,lne ror w~hnrtnnt r,ae Inronn,tbn
<br />eIONATVRE OF PRINCI-Al EXECUTIVE ,
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<br />TYPED OR PRMITED ,
<br />+"~+ntUeV~h+n+r~""^•~+~^v.r,onrnentror-nowtnt.ld.th~s OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION Or AIVr VItJLA T IONS (Re/erence eM effecnmenta here/
<br />~ _ .-"1 .,~. .~~ EVENT I~. ., ' 'r 'l. r~ (~'' :~T`T .-pF,r,ntr-fi :iY tar'u(-.
<br />- - .._~ - ~ PAf3E OF
<br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used ~ TF11S IS 8 4-QBR. ~OfITI.
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