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<br />Form Approved.
<br />PERMII7EE NAMElADDRc~5 (Include Facdrq bar c/L catiwt t} Drier ut NG'IONAL POLLUTANT DISCHARGE ELIidItdATION SYSTEisI fYPDES) OMB N 2d40-0004
<br />~~ ~ I~ NAME "; ~ ,~; OPSCHARG€ MONiTGRiNG REPORT (DN{R) ~ o
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<br />~~ NAMEITITLE PRINCIPAL EXECUTIVE OFFICER [cerd(y under penalty of lase thatthis documentand alt attachments were ~.~
<br />I TELEPHONE DATE
<br />t prepared under my direction or supervision in amordaoce ssith a system designed
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<br />I ~ 6.^^ St to assure that ualiBed ersonnel r i~
<br />,-~ ~ H ; ~, p(,~ I' q p p operly gather and evaluate the informehon ~ ~I J IJ it
<br />submitted. Based on my inquiry of the person or persons rvho manage the system, N V4 `1
<br />: ~ l, or thane persons dmectly responsible For gathering the information, the informe6on q ,,,
<br />r ~ Q ~1~' p~ f submitted is, to the best of my knowledge and belief, true, accurate, and complete { ~D 05 ~~ 7~j f ©Q ~ 0
<br />Iam asmre that there are significant penelfies for submitting false information, SI NA RE OF PRINCIPAL EXECUTIVE 1 /` a`'~" V i
<br />I T ED OR PRINTED including the possi6ilityoflineand imprisonment for kno,ring violations. F CER OR AUTHORIZED AGENT AREA NUMBER YEAR MQ SAY ~
<br />CODE
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
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