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PERMITTEE NAME/ADDRESS (Include FacilityName/Location ifD~erent)
<br />NAME 1
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<br />ADDRESS L.C)?Yi=''Si',T?'t:7 C:s~i~d°{`(~t`.! t'l:~h~;-
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />/', PERMIT NUMBER DISCHARGE NUMBER
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<br />FACILITY { , ,: 1 .. ~ ,, ,.e~
<br />~`"` r" "'~ r",=1r'f's (.+, 3 , ;:~?`. YEAR MO DAY YEAR MO DAY
<br />LOCATION ,- -, ' ' TO ',.: "` '
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<br />Form Approved.
<br />1~ ~ ~~~ OMB No. 2040-0004
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<br />PARAMETER
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<br />QUALITY OR CONCENTRATION .... .....
<br />NO. ..r.~....y ..~~
<br />FREQUENCY
<br />OF
<br />SAMPLE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE
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<br />NAME/TITLE PRINCIPAL EXECUT VE FFFCER I certify under penalty of law that this document and all attachments were
<br />/
<br />` T ELEPHON E D TE
<br />t/ p a prepared under my direction or supervision in accordance with a system designed `
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<br />~ to assure that qualified personnel properly gather and evaluate the information
<br />submitted. Based on my inquiry of [he person or persons who manage the system,
<br />or those ersoris directl res onsible for atherin the information, the information
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<br />submitte
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<br />lief, true, accurate, and complete.
<br />SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />
<br />OR PRINTED I am aware that there are significant penalties for submitting false information,
<br />TYPED
<br />COMMENTS AND EXPLANATION OF ANY VIOL including the possibility of fine and imprisonment for knowing violations.
<br />ATIONS /RPfpranrP all afiachmanfc hc~n~ OFFICER OR AUTHORIZED AGENT AREA
<br />CODE NUMBER YEAR MO DAY
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. PAGE OF
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