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ERMITTEE NAME/ADDRE$S pnc7udeFaci7iryName/Locnnon i Di exenr Form ApprovBd. <br />I B ) NATIONAL POLLIfTANT DISCHARGE ELIMINATION SYSTEM MPDESJ <br />NAME DISCHARGE MONITORING REPORT (pMR OMB NO. 2040-0004 <br />FICKeTMIEE PhCCESSING, .LLC rz-r6) trz-~s/ 'INCA Approval expires0&31-98 <br />ADDRESSNEfr ELLS MINE > C (508A SF) <br />1311 PAENTNCOC CFIYE ~~--' +. PERMIT NUMBER _ G NUMBER F - FINEI LAC115 <br />EYANSYILIE IN 47711 MONITORING PE D CINf kA7.FF. TC FCflGeTOIEE EIVlh <br />FACILITY <br />LOCATIONW E S T C N CC 81 O 41 YEAR MO DAY YEAR MO DAY <br />FROM 1 L Y~+ NC CISCHARGE :#n <br />A T T N: A L F E R R Y. !! A N A C E R (zo-z11 az-zal rza-zsl rzs-vl !ze zs~ (3oar1 NOTE: Read Instructions before completing this form. <br /> (3 Card Ony) QUANTITY OR LOADING ny) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARP.METER (46-53) (54.61 (38<5) (46-53) (59.67 EX OF TYPE <br />(327) AVERAGE MAXIMUM UNIT INIMUM AVERAGE MAXIMUM UNITS (~~! ~84"6e)S 6370 <br />FD SAMPLE $+~Fvv~ TYe., .%~}~. ( 1[} <br /> MEASUREMENT <br />GU4GU I U C RERMIF •Y 5!'s0 " <br />EfFLUENI GNCS'S YALC REQUIREMENT ".~=k 4 '`~'-K ~ cL <br />SCLIDS, 7CTPL SAMPLE vX~S~~ ~~+~~~' ~'~?ik$~ ( IS} <br />S U S P} N I: E L MEASUREMENT <br />OU~.iU 1 U l: ~,~,,: -'~ <br />EFFLUEkT CIiGSf VALC :-'~-°`~r' _ 1!G/1 <br />IkGN, TC?AL SAMPLE ~Yr#4Y n•Y%%+ ~~~~~ ( 15) <br />(A S E' E,) MEASUREMENT ~~ <br />C I V 4~ 1 u C PERMIT `'° <br />tFFLU:N'I' CHUSS YALU -REQUIREMENT :,i~, ~~.` ~ <br />' v - !G/I ~, - <br />CIL ANL` t;hEASE SAMPLE Y7#3~;1 ~+~~-r •e:-:#;13 :2t?~:. ( IS) <br /> MEASUREMENT <br />U;i5H1 1 U 0 ^`s P ~i= ~,. •"?ar3Xr7SrP~ ., # <br />CFFLL'F.h7 ~nGSS YALU REQU '.(- ,~i <br />Y •~ !G/I <br />FLCiti, IK CONDUIT CF SAMPLE U3) <br />I ..#n+$ ~~d;.;lY ~'+'+~~ <br />TriNU 'I)LEATHfiNT FLAA MEASUREMENT <br />Sc,wc 1 U C ~u - <br />PERMIT ~. <br />~ •• <br />~` r <br />t#rt~~## <br />_. <br />.. <br />frrLUf~IT GHGSS YALU E4UIREMENT' - <br />~ ,•~"~ !GD ~ Y• k <br />CIL P.y[` GREASE SAMPLE =~$~~~ 1 94) ~~:~:Y' ^Y• . ~ ~;;;'•~ <br />VISUAL MEASUREMENT <br />B4U66 1 U 0 :rP,EHMIT. `,.~~ ,- _~!" f_°=1 ~':iAO'IpADI#t~ ".- .+ <br />;:fFLUlNT GtiGSS YALU ~QU(AEMEfJT ' n~',1'_~ ;, ~ _. IBC=C ~ ~{'_?` ^. 'A^ •?`° ~+ <br /> SAMPLE <br /> MEASUREMENT <br />~~ aMl~~- <br /> <br />3 ` <br />., <br />. , ~,, <br /> <br />; <br />HE UIREMENT ~_ ~, .: .. <br />~, <br />F~':.~ t, : -a, : <br />~k ,~ <br />` ~_ <br />~ <br /> ~ <br />~ <br />. > <br />. <br />NAME/TITLE PRINCIPAL E%EClff1YE OFFICER I CERTI <br />AM FAM FY UNDER PENALTY OF <br />ILIAR WRH THE INFORM LAW THAT I HAVE PERSO <br />ATON SUBMITTED HER NALLY E%AMINED AND TELEPHONE <br />EIN; AND BASED ON MY DATE <br /> <br />~Lt r <br />. L INQUIR <br />THE IN Y OF THOSE INDNIDUAL <br />FORMATION, 1 BE4EV S IMMEgATELV RESPON <br />E THE SUBMITTED IN SIBLE FOR OBTAINING <br />FORMA710N IS TRUE, <br />~ <br />, ACCUR ATE AND COMPLETE. I AM AWARE THAT TH ERE ARE SIGNIFICANT <br />DI <br /> PENALT IES FOR SUBMITTIN G FALSE INFORMATIO N, INCLU <br />NG THE <br />O~ <br />t.~. (,, /~ 1i POSSIB ILITY OF FINE AND IMPR <br />' ISONMENT. SEE 1B U.S.C . 51001 PND 33 U.S.C. IGNATUR OF PRINCIPAL EXE IVE L - <br /> <br />TYPED OR PRINTED as antler these s <br />4 1378. (Perxlla <br />maximum lmpnsOrment ol6aM1Vee tatures may lnciude fines up ro f10,000 end w <br />n6montha and6 years.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />.iC DAY AYERlGE IS 81GhEST HONTHIY AYG. DORIAG PE~R]CD Ai?FCAT'EC. CII E GREASE - SEE I.E.1.D4 F. 5. <br />EPA Form 33261 (08.85) Previous editions may not t>a U$~. (REPLA6ES EPA FORM T-40 WNICH MAY NOT BE USED.) PAGE OF <br />