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Get Station Code : Reported Date (month Year) : Application : 3me ... - Lm Doe

: 001 J u l y 2004 Application : 811712004 11000004 GD Sampling Station Description : Final Outfall .. . tify under the penalty of law that I have personally examined and am farniliar.with the information submitted and based on my iry of those individuals immediately responsible for obtaining the information. I believe the submitted information is true, accurate complete. I am aware that there are significant penalties for submitting false information. including the possibility of fine.

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