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PERMITTEE NAME/ADDRESS iInclude Fxilitl Namell"ation if fAffeentl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS :' _ t•. <br /> PERMIT NUMBER DISCHARGE NUMBER <br /> <br /> DEN co MONITORING PERIOD <br />FACILITY ;`CA ('iINIE COMPLEX YEAR MO DAY YEAR MO DAY <br />LOCATION 'PEN (-, a? ' FROM TO <br /> '.Y VARCt. RFC1 AMATIOtJ MANA*--` <br />Form Approved. <br />OMB No,4040e006 <br />JC ) <br />NAL ROf J ; 7 <br />tRGE TO SAGE CREEK <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY 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 r f ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT x EPCi ' r - <br /> REQUIREMENT is <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT I?t a r.:; <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMErrITLE PRINCIPAL EXECUTIVE OFFICER 1 eeriif? under penalq of law that thi.d«•nment and all attachment%were <br />rr <br />urrd und <br />r m <br />dire <br />tio <br />cco <br />o <br />ii+ia <br />i <br />da <br />c <br />ith a s <br />tr <br />d <br />i <br />d TELEPHONE DATE <br /> p <br />p <br />y <br />e <br />e <br />o <br />r wper <br />n <br />n a <br />r <br />n <br />e w <br />ys <br />m <br />e. <br />>;nr <br /> to as.ure that qualified prnnnnei properly gather and e%aluate the information ?• <br /> %ubmitird. Raid on m, inquire nr the la-rwa or prr-n% who manage the %}%tern, <br /> or three person, dirertl, re+pm%ihlr for gathering the inp,rmatMn, the information I f <br /> whmitted i.. u, the Ih yt rd my Ln-ledgr and Wwf, Ir,M. aCCIrrair, and Complete. <br /> I am aware that Iln•n• are.ignifi.am <br />emdtir. !.u v,hmiuiug (al? mrormaLkm SIGNATUEIE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED p <br />. <br />inrluding the rye ilnlit ..r rinr and ,mprh,,nmem t.?, I n „o,g , , L fore. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE: YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IUNS (rrererence all attacnments Here) <br />I <br />EPA Form 3320-1 1 Rev 3 393) Previous editions may be used. This is a 4-paffiforni. PAGE OF