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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.
<br />DISCHARGE MONITORING REPORT (DA4R) m I 4C OMB No. 2oa0-0004
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHON E DATE
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<br />submitted is, to the best of my knowledge and belief, true, accurate, and complete.
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<br />i SIGNATURE OF PRINCIPAL EXECUTIVE ??
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<br />including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT 'AREA I
<br />CODE NUMBER YEAR MO DAY
<br />_NT5 AND EXPLANATION OF ANY VIULAI IUNb (Kererence an a1[acnmeMs nerel
<br />w. 3/99) Previous editions may be used. PAGE ---7 Rid form,
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