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PERMITTEE NAME(AODRESS (!nc(vde FanliO~ NamelLomtion ijbiperenrl Nq <br />NAME FICt:ET4iI hE FFCC E;~Iir i., LLi t~ <br />ADDRESSK E M E L li ;'1 T 8£ I~ <br />1911 HMYNTYCCC iEIYF C <br />EYAh:;YILLE I8 47711 <br />FACIUTv <br />LOCATION FROM <br />.E57Ch .:~~'. ~:L,91 <br />n:i':: AL FERkY_ CARACER <br />)NAL POLLUTANT DISCHARGE ELIMINATION SYSTEM1 (NPD ~;~+; . FOIm AppfOVed. <br />DISCHARGE MONITORING REPORT (OMRi91 t` p I NC E OMB No. 2040-0004 <br />Approval expires OS-31-98 <br />~SUrF Eii <br />7 NUMBER ~ ~ . ~ DISGHA ~ F - < < >~ t i I A C A °- <br />MONITORI (310D..:~ "l::t si~iti~ TC FCECATCIFE tIYEF <br />YEAR MO DAY flA~ DAY <br />rzo~zn rzzzn rz assn rte-z9( r3o-3n NOTE: Read ID;t~lCtigns belor completing this form. <br /> 3 Card Ony/ QUANTITY OR LOADING - ~ and ony) OUANTITV OR CONCENTRATIOM! ~' ~--~ NO. fflEOUENC SAMPLE <br />PARAMETER (46-53} (54-61) (3B-45J. (4653) (54~ EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM ~ = AVERAGE M UNITS <br />IBZ e31 ANALYSIS <br />164-68) <br />(69-70} <br />FL SAMPLE # • 4 #aro# ~ drY::^: ( l.) <br /> MEASUREMENT <br />O'JUUG 1 i. G PERMIT 4#>m t0>Q f.E ~ ,~;'°' ~, ~. ~~ ~. <br />< <br /> <br />FFLUENT c,itC59 YALL'! <br />RECUIR~MENT <br />~T~,a~`~ <br />A <br />~lllilCUi' <br />1liiYIPCr <br />°C <br />r~ . <br />., <br />SOLI US, ICIAL SAMPLE '^. 4594#0 tr4::d< ) 1` <br />:i L S P }: Ia U E L MEASUREMENT ' <br />'C7~iU I U O F~RMFT` a~#o ~', .. 4.. ;~'~ >OS+iAdt 9. C <br />~ - C / - ! '.: <br />t.f FLUchT ~e?0.` 5 YdICE .;CgLtUr )y1CNT <br />..il <br />~ -~<'-:,• rq: -. IL'LA G CAII1 <br />: kG/I '_'`~ ~. ~~IY, i - <br />IiiChr TfTA1 SAMPLE :~r::~# <br />~: y. 4II #{. >; ;: t... <br />~ AS F E) MEASUREMENT ~ +~r+•-%'"~ - ~ <br /> PERMIT <br />` -. <br />FFtLue.'~T ~nI:SS YALUE ~~EOUIREMENT ~ r:•• ~•,~~ }~j- ~' CC/I '~ ,CBTk : '~#" <br />'IL AND (:h EASE SAMPLE ,: :::XriC~ >dA ^ CL #r:~ ~: ) l.) <br /> MEASUREMENT <br />U.f_Hl 1 C U PERM17 ova z>:'~ r:'r #s <br />~y , <br />cFFLUef,l GRG55 YAILE ~EQUIREMENT ~"< <br />~: ~~ rxra `:, 't <br />°LO~r IN CChDU7: CF SAMPLE ) ~--) +'%'~~"~~ 4# # ri -0rdd <br />L::nl' :nEA7 Y,E N'I PIA 67 MEASUREMENT <br />~rJ05U I 0 G i .p-EE3MIT EtF ., >0# ## ~, . 4 iri-; '~ ! YS A11 <br />cFFLOt,(iT GRC55 YALLY . <br />'rA~Qn11~EMENT 3C~A #~ ~-;,; tC. ~ '•~~~ <br />IL wfl ii GhEASE SAMPLE .'~r,`:f## ~ ( y4) 'L>: ., C X.V:. ::r Stir <br />Y I S CI A L MEASUREMENT <br />GuUbb 1 U D~ PERMIT ~ E'=i ~7L #-0 „_;., ?~ rod !~ IStI! <br />:. ! C L U E ;. T G 8 0 5 5 Y A L l E . <br />~~I~QLtIR6M~NT ~ ~'. 5 C= 0 "`~ ~ '~ = r= <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIF ~' ~. =~ wN`"~ ` ~ ' <br /> <br />NAME?ITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND ~ TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORMATION REMITTED HEREIN; AND BASED ON MV <br />ONSIBLE FOR OBTAINING <br />M <br />LV R <br />I V <br />1 <br />L <br />~ INQUIRY OF THOSE INDIVIDUALS IM <br />E <br />ATE <br />ESP <br />THE INFORMATION. I BELIEVE THE .SUBMITTED INFORMATION I$ TRUE. nnn <br />~ ~ /~{- <br />. <br />. <br />P~YY ~ I AM AWARE THAT THERE APE SIGNIFICANT <br />ACCURATE AND COMPLETE ~ <br />( <br />/~ <br /> . (~. <br />,f <br /> PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE $12 g~7-7~n oo io ~~ <br />M r^ r k Y POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1B U.S C. § 1001 AND 33 U.S.C. IGNATUR OF PRINCIPAL EXECt1~IVE <br /> <br />TIED OR PRINTED 4 1319. (Perlelfies untler (base sletules may inclutla lines up ro f 10,000 entl m <br />maximum impnsonmenl of between Bmorxbs endsyears.l T OFFICER OR AUTHORIZED AGENT AEA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />GUMMEN I S ANU EXPLANA I IVN OF ANY VIULA I IUNJ (Here/ante au 8((acnmenT3 neleJ <br />~+: LAY AYEc+AGF IL t3Ctt5? CSOhT4LY AYG`. DUfiING PEhICC hc1ChTEC. CII c GILASt - °_EE I.t.1.Lr F. 4. <br />EPA Form 33261 (0&95) Previous editions may not be Used.,., ' ~ . (RERLACES EPA FORM T-4(1 WHICH MAY NOT BE USED.) C C C G 3I C C C 111 ~ I f ~ C PAGE I OF <br />