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<br />NATIOMK POLLUTANT DIBCHMOE ELIMINATION SYBTEM INPOE$l
<br />DISCHARGE MONITORING REPORT IOMRI
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<br />PERMIT NUMBER DISCHMGE NUMBER _
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<br />Form Approved.
<br />.. OMBc No..20,40-0004
<br />Approval sxpiree 05.31-98
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<br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FA FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND
<br />MIUM WITH THE INFORMATION SUBMITTED HEREIN; AND BARED ON
<br />) ~ TELEPHONE DATE
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<br />MY INQUIRY OF THOSE INDINDUALS IMMEDIATELY RESPONABLE FOR ,
<br /> OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS
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<br />SIGNIHCANT PENALTIES FOR SUBMITTING FALSE INFORMATON
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<br />I ~ THE POBSIBIUTY OF RNE AND IMP11150NMENT. SEE 18 U.S.C. !
<br />001 AND 33 ~
<br />gIONATURE OF PIIINCIPAL EXECUTIVE 1- i
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<br />EPA"Fam 3320.7 108-951 Previous edlDOnd'mey be used.' IREPLACE6 EPA FORM T-40 WHICH MAY NOT BE USED.I PAGE OF
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