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P[a M~T~E//NAM C/ADDRLLL (/ntlYdt <br />F,cllily NL R b,Q t r I <br />NAM[ "tY~(;,.L~'~t'~ cOnPnNY, TH` __--- <br />wooR[B~.,RASSY GAP NINE ____ <br />___ONE EAST EIIL~AUKE:: STREET ' <br />_--JARESIIILLE______ SiI ~~T- <br />-AC0.1TY _ <br />-___ <br />LOC wT10N __ __ <br />A'PTN: !SAHLA RABUCK, Y1CE PRESIDENT <br />NATIONAL POLLUTANT DI]CN wpO[ FLIMIM ATgN FYSTFM (NPDE51 <br />DISCHARGE MONITORING REPORT /DMRI <br />7~I6 I7-I9 <br />COGS U2 ~ A <br />PERMIT NUM B[R DncHwwoF NwAu <br />MONITORING PERIOD <br />YE A Y O D <br />FROM Tp <br />(ao a/) ru aJl lx.as/ ne- » (7b.:9~ (a u <br />r" <br />M S N U }t ForEp pj~5~vfid. <br />(S U b R N a j OMB ~(Y. ~2A40-0004. ~' <br />F - FS y A LApproval expires 630-91. <br />PIT CL CSC46G TO GRASSY C4E8i: i. <br />°~~ Flu DISCHARGE ~XX ~ avr <br />NOTE: Ra[d instruetionE before completing this form <br /> (! Card DnIY) QUANTITY OR LOADING (~ Card Only) QUALITY OR CONCENTRATION <br />NO FR [OU Ewcr <br />SAMPLE <br />PARAM [TER 1~6-1)) (11fi1) (JB~J) (t6JJ) (11.61) . <br />~ OF TYPE <br />(37-37) AVERAGE MA%IM UM UNITS ~ MINIMUM AVERAGE MAIM UM UNITE <br />b76J) wNALreI] <br />(eJde) <br />16910) <br /> ~ v ` ;~ <br /> 6AMPLE <br /> MEASUREMENT <br />~ <br />0460 1 C U <br /> <br />' <br />' A ~~ <br />REQUTAEY ENTB ~x <br />xa~.~ <br />g ~, <br />" <br />a~ <br />~p <br />E <br />s a#a <br />y ~ ~.~ ,~~~ <br />~` <br />~ <br />~ f~~" ~ I h ,~ <br />~ <br />' h. ~:~~~~~~ <br />>3~a~ce .:- <br />" '~~ <br />g ~~ <br />r! <br />Y ~ ~~ <br />~, <br />d <br />rLUENT GROSS VALUE <br />F S <br />$~ <br />R <br />m~a F~ <br />W <br />; <br />wa <br />p A <br />%}VA ~ <br />I <br />7~1 <br />~~EI;E <br />1 '~B <br />$ <br />~~~~ <br />~ ~E <br />~-k <br />,NX~pQ~S SU k}~e <br />~ ~~'~~=E ~ <br />- <br /> ,,,,, ~ #" <br />.a . <br />~. n <br />, _ <br />, , .k <br />OLIDS, SETT EA E '~' -' '~ ~" ~ 2S1 <br /> HAMPLE ' ~ <br /> MEASUREMENT ' ' <br />0545 1 0 0 •.PERi+1s'~ i,a.~. R« <br />~ <br />~ ~° <br />~ .x~;~ ~ t ;t= <br />~~ <br />~ ~Y .~~~ <br />~~ <br />~ <br />~ ..~ "€E~r~~"~~ <br />~ <br />~ %~.a <br />~~ »~. ~~u A'~~. <br />~ <br />FFLUENT GROSS VALUE PeourrtENeNt *aa.~,~ <br />„ <br />p <br />~ <br />r , <br />~~~~g~~~~ ~~+<lu ~~~~ <br />~~~ ~ <br />~ <br />z~ <br />3" <br />" ~ <br />K~ <br />0~~~ CL L <br />/ <br />~ <br />~~5 ~ ~~~ <br />~~ <br />~ <br /> F <br />~ , , ~ <br />~ . <br />~, m~g~~~-~ <br />~ r ~ ~~ <br />. <br />I :, 1 ,. <br />I v > <br /> HAM PLE <br />REGR Ed~I'R-GRAY hE. ~I'R MEASUREMENT ' <br />OS56 1 C G : ° .~ s <br />N ° °X~~!t .~ f <br />I <br />' a ~.~; +o-tru~l~ <br />+~~ <br />~ Ts:~o ~ . ,~,• ~ <br />'~° <br />~z ~~I~#~~~~ .w <br />.~w <br />: <br />~ 1 ~~ . ~ tam <br />~~z <br />~ ~:~ <br />.~~: twl g $~$~~°~ <br /> <br />'FFLUENT GROSS VALUE eleNr~ <br />'eouR <br />"ri <br />~ <br />_ g$ <br />~m;~~.« <br />~ a <br />~~~~.~~~a <br />~~ <br />~ <br />~ <br />uaca ~~ <br />~~~ <br />~ <br />~~~~, ;~ <br />~~ <br />~~~ .~ <br />, <br />~ <br />~!!1"~~ <br />~ <br />l7G/L s <br />' <br />`5~~: ~~~.~ <br />:~ <br />~ <br />~ <br /> ; <br />~~. ~~ <br />~; ~= ro~ra~;~ <br />~ <br />~ ~ ~. vt:a~~~~~~~. .m~ <br />~ <br />>r 8 ~® <br />~~~ <br />EON, iN CONDU T OR uu u c ~+.~~f <br /> 9AYPLE <br />dRU TREATt1Ef:T PLANT MEA6U REM ENT <br />0050 1 0 0 e ` <br />• <br />A ~ ~~ ~A ~ <br />' ~ <br />~ a•k;~ ~: <br /> <br />GRO <br />FF <br />E <br />S YALUE + <br />P[R11YT <br />REQUEf~CMENT~ .%~~..~, % <br />'° <br />s~ <br />' :.a <br />~~ <br />Y <br />~ <br />~t~ <br />O ~' .~~~.~ ~: <br />~ <br />~ <br />~i~ ~~~.-~~~`~$m~ <br />~~~ :,. ~~~~-"~~~ <br />~ <br />~ <br />" <br />~~ <br />- <br />#~~c ~ <br />~~ <br />° ~~~ <br />3~~' ~~~ <br />~m <br />~~~a <br />LU <br />NT <br />S a JY~'li <br />A <br />1~: <br />w r <br />; <br />D <br />Sf;ll~;i~ EfG _~~~. <br />: va <br />~..~~~ ~ <br />~~ <br />~. <br />-.k~ <br />; ~ <br />~ t <br />a _ <br />OLIDS <br />TOTAL Yi'{I+iY.:{'f J}I}~r}.rfiT ( ' ~'liYYlit(r`:~ %7~IfJQril ( 191 <br />, SAMPLE <br />ISSOLYEG MEASUREMENT _ <br />O2yS I O O a & &~ <br />lp <br />~ <br />i Ygt Ax <br />i~ <br />° <br />~ <br />`~ m <br />sY~ <br />~ yF TiO ~w <br />~~~ •~ ~;a" e g& <br />~ <br />~ m~`° ~ .~ <br />a:a <br />~ ~~a <br />~ <br />; ;a <br />~~~~fm 1 ` ..~ <br />~ <br />, <br />`PFLUENT GROSS YALUE aM <br />;~e~°v <br />H <br />, ~ <br />, <br />~ <br />~ ~ ,~s.,,. #0~# . ~ <br />~ ~ ~ , <br />~~~~. <br />IL ANU GREASE ~~`~`4'#~ ~ 94) <br />( o~a~~~~ Y~~. ~'~ ~~'~'#~~ ( ) <br /> SAMPLE . <br />I S U A L M EASU REM ENT - <br /> <br />'4066 1 0 0 tt m ¢ .® ~ <br />~~rEaMtT~s ro s. t~ ~~~ <br />a~~4?>k~ ~~ fi ~'"~ ~~ <br />~ ~ i~~'~~ ES=L ~ # >ti']g <br />'~~ ~ =~.~ $~ <br />'a~ <br />' ~ 7~t <br />~~~~ '~'~~ O#T1 :F 8-, <br />~ <br />S~i~a <br />' <br /> <br />'FFLUENT GROSS VALUE REGUjREMd'NT~ ~,i ~&a~" <br />~ a~w , <br />~ <br />~ <br />~` <br />~~ <br />~ <br />NU=O ~~ ~~a ~_~~ . <br />~"~~~ <br />~ m.• ~~" ~~~ce.`a~ ~ce <br />~~ ~~- Ak%Y# ~~"~ i~~~ <br />~ ~a.na '~ <br />~~ <br />s <br />~~ <br /> ; ~ <br />~~.,.~a.,, . <br />. <br />.° <br />.~.? <br />~, ~ w~s ~ <br />~.~ya., . "~~, . <br />~:w~., e~ .. . - <br />~~ <br /> SAMPLE <br /> YEAHUREM ENT -~ <br /> x.~'P[RN .~~G`..°° ec~{ew.>em~~g,~m~ <br />' °`L~~'~®~~ <br />~~~ ~~ ~~~~ ~~ ~~~'~$ffi ~~:~_ ~~~.$~~~'~'~< <br />~ <br />~ <br />~ r$~ F,* <br />~ ~&~~~;X~,~ <br /> IR[dUlR~ l~[N p$ a <br />~ ~`~ ~ffia~ ;' ~~ ~' <br />i ~ r ~~~ ~~.~~& <br /> x ~ $ a , <br />NAME/TITLE PRINCIPAL [%[C UTIVE OPPIC[R I CCRTIFY uNOO1 RHALTr OF Lww THAT I HAVE PERSONALIr E]AMINED <br />wNO AM F411LIM WITH TNF INFORMATIOfI 6UHMITTED HEIIEIN: AND BARED T[LEPNON[ D A T E <br /> <br />ON MY INQUIRY OF_ T1g5E INOIVIDUALH IYMEDIATEIr R[6FONHIeLE FOII <br />'~ <br />OHtAINING THE INFORMITION <br />1-BLUCVE LNF $l1BMITTEQ INFQPYAT <br />Karla. Rabuck ~~ <br />. <br />5 TRUE ACCURATE}ANO COMKRL I AY AWARE. THAT TNLRE AR[' <br />Vice PResident NIFICANT PENALTI[5 Fp1 6UWIfTING FAL$[ INFpIMATION IHGLUOING !~ <br />THE P055~eartr'Or nwE ANO IMPRI60NMFNT'6E[ IB u6C f 1001 AND 6 NATURE OF P INCIPAL E%ECUTIVE <br />]]USC 11]19 IRw.hv. uMrP Yr.r w]Wm nuv Mrldr /mrr <br />n <br />]I4Mu <br />608 754-2291 <br />93 5 <br />19 <br /> • <br />]P <br />Em <br />wMS <br />/M <br />mA <br />a A <br />TY-ED OR PRINTED u <br />. <br />.w.r <br />w,dor nom~um wnnvu~mrnr ~. <br />mn <br />OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENT AND E%PLANATION OF ANY VIOLATIONS (RrJrr,nrr u0 ullurhmrnf[ hrr,) <br />SETTLEABLE SOLIDS LIi~IT APPLIES GNLY IF <= ld-YR, 24-HR PRECIP EYE(rT IS CLAI;IED. IE' CLAICI APPROVED BY <br />AQCD, T55 E IRON LIf1IT5 GILL NOT BE APPLIED TU REPORTED NEASUREEi°NTS--SEE I.B.lA, PG ~ ANC I.b.1C, PG ti. <br />orm RSV. ~ JBVlDIia Bdi onH may De used. IR[PLAC[L EPA -oRM TrD WNICN MAY nor BL ULED.I 00(;7B/921615-1n3:~I -ACL 1DP <br />