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PERMITTEE NAME/ADDRESS (include Faeilip~Name/Loemion JDiBerenU <br />NAME pICP;cTdIPE FhCCE°SI;~~. LLC <br />ADDRESSN E N E L N C. I ;{ E <br />Lill o6Eh7M000 CfIYF <br />EVAhSYILLF IN 47711 <br />FACILITY <br />LOCATIONEST.CN CC &1C9I <br />A ': 'Ph[ AL FF.NFY_ CAA?Lf f. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION <br />DISCHAR/GE MONITORING REPORT <br />GCCG C <br />PERMIT NUMBER ol,c <br />FROM <br /> <br />(NPDES) Form Approved. ~ <br />I ~ C h OMB No. 2040-0004 <br />gpproval expires OS-31-98 , <br />ILrE _°F) .n <br />illMBER i~ F I 1 A I L~ YY <br />FUNCFF.iCNE _`/FCFCAICIFF F11EF <br />DAY <br />~ a>s tiscxafcE i~i °'~^ <br />(sa~rl.Read Instructions befor completing this form. <br /> (3 Card OntyJ QUANTITY OR LO (4 Card On/yJ OUANTITYO TION NO. FREOUENC SAMPLE <br />PARAMETER (afi-53) (54-er) (36-as) (46-53) (5a-er) EX of TYPE <br />(32-37) AVERAGE MAXIMUM MINIMUM AVERAGE MAXIMUM UNITS - <br />/6z.87 ANALYSIS <br />(64 66J <br />69-70 <br />H SAMPLE ~ n .::~ .; r: ..- :: i :; K" : S :; ' : ( I ~ ) <br /> MEASUREMENT <br />rc4au L u c PEatatT *. ~' ~~ # - :x~ _~;~ <br />~y i.~tt1 v~Ilu <br />f'FLUtNT Gt<i75E L'r1LLE RL;9UIREMENT K %'£~ !j `j ~ ;;y; ;- ~ !1J)~~ @ ~~ `" <br />GLLU5, 7CTAL SAMPLE ~'''AV"' „`K'K" ~.aa0 <br />~ ( 35) <br />' G S P L ti C F C MEASUREMENT * <br />;;U.fO 1 G G -PERMIT Cd4 a x#, a =:"c # ~ <br />J' •.,,.~.; - - 'E7 >. ~lE.~ <br />tEfLUF.tiT C;hCSS YALLF FiE~UIREMENT KS+::: .~- .~~.I',.;'~'3 hC/1 Qxrl~' <br />UCLIGS~ ~ETTL EAEI P_ SAMPLE - "°" ~`'''`'`~ ^K: r. >r ;:a "_ _ 9a+0 ~ iL) <br /> MEASUREMENT <br />0545 1 (i U <br />PERMIT Oq. .1# a a,~£r: a ~:" £##. ~' <br />~'. ~. `- ~ ~'C •C. ~' .E"~~'. <br />fFLIIE!;7' C.rcC55 YALLE fl6QUIREMBNT - Y` rl/I 6 1'@ ~ <br />I i+IJhe TOTAL SAMPLE ur,: ~-:: <br />r. <br />r .... . <br />,. ,;a #>d•' ~. ~ ~ 1~) <br />(A ~ F E) MEASUREMENT \ _~• " <br />L U 4 ] I U Q ~ II #1D KI £ 5 a } # r <br />+ <br />' ~r / # a? *:"-^~~"s ;t~. <br />~:•'FLL'E.vT CriGS9 YALLE :Fi4'CUIFiFMCNi' , ~ *~::~ <br />- ~. J~~i., ~i/1 <br />~L F.Hi! C,AEASE SAMPLE 4r: re r;r,.:; - . ,: :~ ~.r,~~,£a aAAaa ( 1S) <br /> MEASUREMENT <br />i 3.5 r1[ I V Q r ~ ~~.. II# rp <br />' aAa>t'i II;x- # r, .. ##1G # r, :-;' ,fi.3n~ y ': '~ ': ~~' <br /> <br />F r L U E h T L; h 0 5 ~ V A L U E <br />~I~~i<U'T <br />. <br />r, r :; ,: <br />~' <br />'~~$~~ ~'~; <br />F E/ L <br />`. <br />.~'~'~',:: _ <br />,+ , <br />Lr~w, IN (:GNU 1T CE "SAMPLE 1 ~?) "• fi{C,}tii ataaKC <br />? :' h U T f: [ h'I C,~E N I P L n N l MEASUREMENT <br />. I,uSU 1 J G T~ <br />~I.A~'(~ <br />r -4- ~ R '~ <br />•L B C);~'t <br />4 aKroaa 40V ~ .,, <br />r Yi <br />~ ~{. <br />~ <br />4 {.. =.a <br />LFELUF:tt'I GeC53 VALUE ~~ <br />iCIl4)~kfdi" $6.1t~t ~ '~~Z~ :=;~~i:` !GC' .~ ` Y VJ r <br />IL ANl'. fi :`LASE SAMPLE r,~,pn;"Ko ~ ~:U) r,:}>;: :, r,. ~. ,:; r, y^nr ~K:Kf, <br />L li ti A L MEASUREMENT <br />4U(IO 1 U U .., <br />~EF1Mhi' <br />+ _ .. Fc.1 i # ## rb$ ?I'~ ~''• r <br /> <br />` ;.'~'~. '~>SC: <br />QHI}LE(v1 <br />EN7', , ' <br />^' <br />':°:'LUt::1 GeCSS YALL[`~ eaac <br />~ ;'6C=G <br />4, "" <br />, <br />, <br />, <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF <br />AM FAMILIAR WITH THE INFORM LAW THAT 1 HAVE PERSONALLY EXAMINED AND TELEPHONE <br />ATIONSUBMITTED HEREIN: AND BASED ON MV DATE <br />INQUIRY OF THOSE INDIVIDUAL S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />AA 1, THE INFORMATION, I BELIEV <br />RATE AND COMPLETE <br />n L <br />A <br />L <br />r r E THE SUBMITTED INFORMATION IS TRUE. ~, ~•' <br />I AM AWARE THAT THERE ARE SIGNIFICANT <br />~ <br />\ <br />. <br />- r <br />CCU <br />. <br />~ <br />PENALTIES FOR SUBMITTIN A [ <br />N <br />G FALSE- INFORMATION, INCLUDING THE <br />)Z ,) <br />~ 1 <br />POSSIBILITY of FINE AND IMPR <br />M ISONMENT. SEE IB U.S C. 4 1001 AND 33 U.S.C. 1$IGNATURR <br />~ <br />OF PRINCIPAL EXECUTI~E / <br />^ h IPenetties antler mesa <br />§ 1e1s la~o ena o. <br />sraru(es may incmtle roes up ro aro ~ <br />YY <br /> . , <br />tl5 OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />ED OR PRINTED maximum impnsonmenr olbeMree ysers.) <br />n6monlns en <br />COMMENTS AND h7(PLANAI ION Uh ANY VIOLAIIVrvS (rre2renca an aaecrurrams naroJ <br />.iU L'AY AYEt+AGE I° escresT t1GNTNLY dVG. JUFIlG Fb1;ICL hEFCATEL. Ct1 E 6AEASE - =FF I.E.l.t~ t. 5. IS` d <br />7C.'P6L IbCb LIrIT£ YIIL UE ~/ILYFC. ANG SETILEAELE __°CITL~ CIiII: AFFCIFL FCF <=1CYF.i4HF F"FFC1F FYkb7-SFII. <br />he bsBd. ". ~y.,;~~6tiwp,GE,S EP,A,FORNl T.40 WHIOHMAY NOi~6E tl$Et7.)- ` -_~~' OJ,' IjI ~Q C ~ 11' 1 ~.ri'F.f , . rte"` i <br />