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PERMITTEE NAMElADDRESS ~Inclnd~ Farilif}• .wmdlixatian if UtfJornl) <br />NAME <br />ADDRESS ~:CA h'IINF COMPLEX <br />P~?X 67~J <br />`~F^! c. ~ f31 i535 <br />FACILITY _tCA "7Ir•!E COMPLEX <br />LOCATION ~-,;_~ CJ B1o35 <br />., F~f;f'O, .~'tEt~f._AI`~gTI01~1 t`TAIVA~~~R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 240-0004 ~ <br />M I t~' <br />i 5l <br />n~:CHr~ TO -rRIn;•I`,~H ~t~~GK <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ_ FREDUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE , <br /> MEASUREMENT ~ ~ ~ <br /> PERMIT <br /> REQUIREMENT ' <br /> SAMPLE Ir' <br /> MEASUREMENT ,. ~ ~ ( ~. v <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />i <br /> MEASUREMENT ~ - -••- ~j <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ,. - ' <br /> PERMIT ._ ~ . <br /> REQUIREMENT <br /> SAMPLE <br /> <br />MEASUREMENT _ <br />_ <br />`- ~ . .~ <br />I <br />~ <br /> PERMIT _ :...; ; ,-. _, ' i . , <br /> REQUIREMENT <br /> SAMPLE <br />~ ~ <br />` ~ '~ <br /> MEASUREMENT ;. <br />~ <br /> PERMIT ~, t <br /> REQUIREMENT <br />' ~ <br />I <br /> SAMPLE ~ ~ ~ ` I ~ <br />`~(/ ~ I ~ <br /> MEASUREMENT - • - <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 crrtif~ undrr prwih of law th.u thi. A,a umrnt and all aUachmenh werr <br />d TELEPHONE DATE <br /> prrpurc <br />urufvr m, dintiinn ..r wprrs isiun in :xcordancc with a ,~,trm dr+i¢nrd <br /> to as urr that yualifird prnunnel propcrl~ Kather and r,oluatc• the infnrntatlon I <br /> submittrd. Raxd un m. inyuin of the perwn ur prrson, who mrnrKe thr .farm. ~ ! <br /> nr th~~,r per,uns dirxctlf rr,pomible for gutherinG the information, thr in/ormatiun ~ <br /> suhmittrd is. I,. Ihr hest of m~ knuwledRr and helirf. irur. accur~te.rml cnmplrte. I <br /> <br />I :uu a...,r~~ that ihrre arr,ignifK~anl prnattir, fnr wbmitting falu information SIGN URE OF PRINCIPAL EXECUTIVE <br />l <br />TYPED OR PRINTED . <br />a„ludin;t ibr p.~,•ibiiit. of finr alai impri,onmrnl fnr 4m,winq,iututlunw OF ICER OR AUTHORIZED AGENT AREA <br />D NUMBER YEAR MO DAY <br />cvmlatNlS ANU EAPLANAIIUN Ur ANY VIVLAIIUNS (Heterence all attachments here) <br />~TR~D TO RE3UFS <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. ~OQ41 Thi~_is a 4-part firm. <br />