P[a M~T~E//NAM C/ADDRLLL (/ntlYdt
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<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 _
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<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
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<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
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<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
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<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
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