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PERMITTEE NAME/ADDRESS (Include Faci(ip•Name/Goomion jDij(erem)
<br />NAME FICftETaIBt: FhCCkt:IhC, LLC
<br />ADDRESSh E M G' L h l! I N F
<br />1311 HRctiTi+CCL CFIVE
<br />E'YANaY1LLE lh 47711
<br />FACILITY
<br />LOCATION L 5'T C N C O 81 G 51
<br />,LATIN: nL tLrii•Y, CARF.Cfk•
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR;
<br />(2 t61 (tr~ e)
<br />PERMIT NUMBER DISCHARGE~NUMBER
<br />MONITORING PERIOD
<br />Y- ~~. MO DAY YEAR MO DAY
<br />FROM 4 C ~ TO : (•
<br />(4621) (2b33J (2a. (16-zlJ (26-29) (3431)
<br />Form Approved.
<br />w t 6 C ~ OMB No. 2040-0004
<br />Approval expires 05-31-99 •,
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<br /> rszc.3J (sa-sa) 69-70
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI
<br />AM FAM FY UNDER PENALTY OF j
<br />ILIAR WITH THE INFORI
<br />T AW 7HgT 1 HAVE PERSONALLY E%AMINED AND
<br />ATION SUDMITTED HEREIN
<br />AND fl45ED ON MY TELEPHONE DATE
<br />r
<br />INQUIRY OF THOSE INDIVIDUAL
<br />THE INFORMATION
<br />I BELIEV
<br />~ ;
<br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />E THE SUBMITTED INFORMATION IS TRUE -
<br />,
<br />y
<br />' ~' r ~ 1 ACCURATE ANO COMPLETE
<br />- ,
<br />I AM AWARE THAT THERE ARE SIGNIFICANT ~
<br />.
<br />PENALTIES FOR SUBMITTI FALSE INFORMATION
<br />INCLUDING THE '
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<br />M w Y\ (~ (' POSSIBILIIV OF FINE AN4IMPRI GO
<br />.
<br />SONMENT. SEE 1R U.S.C. 5 1001 AND 33 U.S.C. IGNATUR OF PRINCIPAL E%ECUTIV~ ( ~ 1 ~~ i d(~ 01
<br />§ t3t9. (Penekiat under fflgpB s
<br />TYbED OR PRINTED maximum impdsmmenrol bAMe9 feNres mey include lines up ro SI0,000 and w
<br />n6 mourns endsyasrs.J OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND F>(PLANATION OF ANY VIOLATIONS (Re/erenCe all aftaChMents here)
<br />SU DAY AYFRA(rE IS NICkEST CGMThIY AYG. CUAIFG PEf1ICC ficFCFTEC. CIL E CElA$E~- :EF I~~a].C~ E. 5.
<br />EPA Fo[m 3320-T (09.95) Previous editions may not be used. _ ~ P.k/ICES EPA FOpM T-40 WHICH MAY NOT'9E USED),, -~ ,,~ Q C 16~ CC C 1 1 I - I fj J'E PAGE 1 OF
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