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PERMITTEE NAME/ADDRESS (include Facility Name/l-afion if iverrnl) NATIONAL POLLUTANT DISCHARGE ELIMINATfON SYSTEM NPDES) <br />NAME - DISCHARGE MONITORING REPORT (D R) <br />ADDRESS t <br />00 X PERMIT NUMBER DISCHARGE NUMBER <br />LIEN MONITORING PERIOD <br />FACILITY E-CA p?ICOMPLEX YEAR MO DAY YEAR MO DAY <br />LOCATION DEN G17 f31 c. FROM TO <br />s uAR1'1. RFm AMATTttN MANAGE ' <br />Form AM ved. <br />OMB No. X40-0004 <br />MINOR <br />(SUDR J <br />F - FIN <br />D5CHG T <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUE14CY <br />OF SAMPLE <br /> EX 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 <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif. andrt jwnalq of law that this document and nil attachment we" <br />" <br />w <br />i <br />th <br />d <br />i <br />d TELEPHONE DATE <br /> prepar rl under m% direction or,up- <br />on <br />n ami <br />ance wi <br />a ryaem <br />es <br />gne <br />that yualtned personnel properl% gather and esaluate the information <br />to assure 4?) <br /> submitted. Hased on mi inquire or the Person or perams who manage the %)stem. <br /> or those persons dime tl) responsible for gathering the information. the information <br /> submitted is, to the best of mi know ledgr and belief, true. ascuratr, and complete. <br />f <br />6 <br />I <br />h <br />h <br />i <br />ir <br />L <br />L <br />i <br />i <br />h <br />t <br />i SIGNATU OF PRINCIPAL EXECUTIVE fl -) <br /> want p-Al ir. <br />o .u <br />omal <br />"n. <br />am aware t <br />at t <br />em am s <br />gn <br />m <br />tt <br />ng <br />a <br />.- <br />n <br />: <br />OFFIC OR A <br />THORIZED AGENT <br />AREA <br />TYPED OR PRINTED rw udtng the lxwsibiliti of fine and nnpt n-ann,ot f, knowing sinlmi m,. U <br />i DE NUMBER <br />CO YEAR MO DAY <br />C:UMMtIVI' ANN) tAVLANAI 1UN yr ANT vlvu+ttvtvQ Inetararrca nit auawrrnanla rrara/ <br />VUHJE <br />EPA Forth 3320-1 (Rev. 3199) Previous editions may be used. 7=- i :7 '17T .'iris a d-Prim farm.