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PERMITTEE NAME/ADDRESS (Include FacX(Y .Nomelbiration ifthfferenti <br />NAME <br />ADDRESS i'.. _ . <br />VUX 670 <br />r.Fra cD 8163 <br />FACILITY ' CA MY(,;: '_;/JMPLEX t <br />LOCATION DEN C ti 8163 <br />Y KAF?n RFrI AMAT rnm MANAC'-FR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) NOR <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />NOTE: <br />Form Approved- <br />OMB No. j040-0004 • <br />Read Instructions before/Cmpletinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY 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 <br /> MEASUREMENT <br /> PERMIT a <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I tvrtifv under penalh of law that thin document and all attachment. were <br />d <br />d <br />ms dir <br />cti <br />o <br />s <br />ith <br />i <br />l <br />i <br />d <br />t <br />d <br />i <br />d % TELEPHONE DATE <br /> prepare <br />er <br />e <br />on <br />r <br />uper <br />on <br />n accor <br />a ys <br />un <br />s <br />ance w <br />rm <br />es <br />gne <br /> to a+wre that qualified penonnel propel gathrr and ei aluate the information <br /> submitted. Rased on mv inquin of the person or penom who manage the system. 14 1 <br /> or throe perstats dirrcdv resptmiblc for gathering the inrormation, the information <br /> suhmit0.d is, to the bust of m. knuwledgc and belief, true, accurate, and complete. <br /> 1 am aware that were are slanifi-ant penalties for submitting false information SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED , <br />including the pin.ibdn? of fine and imprhonmeat for knowing slolatiom. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODEJ YEAR MO DAY <br />vvm... a_??.v .-s....r ?nr ?..??rs ?.v?. v? e.?•. ..v vs..v?.v t. c.c•cns.c w.. wow....n.c.ao um c/ <br />RD <br />;QUE ST(' A REASON <br />INALYSIS B1 <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 00060. " i*%'i% a 4-partl6nn.