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FERMITT[[ NAME/ADDR!!S lJRClud[
<br />FerlTlry Nelne/Lo~plly ~diffirsnu C O tl P A N Y T H E
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<br />___ONS EASR PIILYAUHEE STEEET_ _
<br />JANESYILLE YI 53547
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<br />LOCATION --------------__
<br />ATTN: RARLA RARUCR, VICE PRESIDENT
<br />M ATION AL FOLLVTANT DI]Cn Aq G[ ELIMINATION ]VST[M lNPDEJ,
<br />DISCHARGE MONITORING REPORT /DMRI
<br />1 l6 1719
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<br />-ERMIT NVMe[R Dr.cnwgR. nMMeeR
<br />MONITORING PERIOD
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<br />tlIYOR For A ved.
<br />(SUBH aY) o(Y1~40ao-ooo4.
<br />F - FIYALApproval expires 6-30-91.
<br />PIT /5 DSCBRG TO GRASSY CREEK
<br />#~ NO DISCHARGE ~~{~ ###
<br />NOTE: flaed in[truetion[ before eomplatiny thif form.
<br /> (! Card Only) OU ANTITY OR LOADING (I Card Only) OU ALITY OR CONCENTRATION FREOU ENCr
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<br />NAMERITLE PRINCIPAL EE[C UTIVE OFFICER CERTIFY UNDER PENALTY of LAW THAT I NAVE PER]OHALLV []AMIn[D
<br />l
<br />AND AM FAMILIAR WITH THE IMFONMATION $UBMrTTCD NCRCIM AMD BI,S[D TELEPHONE D A T E
<br /> ON MY INQUIRY OF TNQrE INDIVIp1AL$ IMM[p1TELT RESPONSIBLE F ~
<br /> OBTAINmG THE INFdiMATge I BELIEVE TMC SUBMITTED INFOR O
<br />Karla Rabuck IS TIIUE ACCURATE AND COMPLETE I AM gWARE THAT TM[RE
<br />NIrIuNT REnunes FDR suslmme FALSE InFORMATIDN maup"D
<br />
<br />TN[ POSYBILRr O< FME AND IMPR50NMENT SCC IB USC 1 IOOI AND 608 754-2291 93 DR 26
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<br />JJ OSC 1 Ill9 rRnellm uMn Ibr uululr. nu mrldr /Inn e
<br />In lIrLIFu 6 DNATU RE OF PRINCIPAL EREC UTIVE
<br />TYPED OR PRINTED y
<br />o.d~,.ma.,~irm•nipr,~nn^..•.I ••/MluwnEmnnlA. end i.wr.r OFFICER OR AUTHORIZED AGENT A NUMBER YEAR MO DAY
<br />COMMENT AND E%PLANATION OF ANY VIOLATIOrvB (RTJerrnre ulI ul(ul'hmrnli heir)
<br />SETTLEABLE SOLIDS LIBIT APPLIES ONLY IF <= 10-YRe 24-HR PRECIP EVENT IS CLAIBED. IF CLAZtl APPROVED BY
<br />Y1CIi, TSS E IRON LItlITS WILL NOT BE APPLIED TO REPORTED BEASUREBENTS--SEE I.B.lA, PG 4 AND I.B.1DF PG 6.
<br />EAFOTm 332P1(Rw. P88)Prevloue editions may be used. IR[PLwc[][Pw FORM T-.e wNlcM MwY NOT [[Y[[D.I 00079/921016-1635 PAC[ 1 of
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