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PERMITTEE NAME/ADDRESS pnclude Faciliry NamrlLocarion ifDgerenr) <br />NAME FICiit'fNIFE FRCCESSING, LLC <br />ADDRESS N E 4 e L R C I N E <br />1311 BREBTIYCGC CFIYE <br />EYANSYILIE IN 47711 <br />veru TTY <br />NATIONAL POLLUTAM DISCHARGE ELIMINATION SYSTEM MPDESJ <br />DISCHAR/GE MONITORING REPORT. ~MA(B) "I N C F <br />(su6R SE) <br />MIT NUMBER DISCHARGE NUMBER F - FIRAL <br />MONITORING PERIOD ACUTE Q Z T <br />Fonn Approved. <br />OMB No. 2040-0004 <br />Approval expires OS-37.98 , <br />TE`T,I~G FCF CC1A <br />LACA~ <br />LOCATION MO DA Y I~ YEAR MO DAY <br />' <br />' <br />W E .. T C N C G E 1 C 91 <br />FROM FTO z ~ ~ '"'ter ~ISCRAHGE ~~ + <br />~ <br />+ <br />A T T N:' I F E R R Y, C A h A G k fi (zazll yz; ~) tz4 (zrrz~) (ze ze) (a>•s1) NOTad Instructions before cpfnpleting this form. <br /> (3 Card Ony) QUANTITY OR LOADING t (4 Cerd Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-5G) (5461) (3845) (46-53) 54-67 EX OF TYPE <br />~'Yn AVERAGE ~~ ~ IMUM MINIMUM AVERAGE MAXIMUM UNRS' <br />(6243) a1Ja-YSis <br />84-68 <br />6&70 <br />LCSU STATFY, ytHh AC SAMPLE ,~~~`~^ „~^~~`^: -~•%~~ .•~~~$w ( 23) <br />CERIG~ApE9IA MEASUREMENT <br />TAN3P 1 G G PERMIT . IS>C'P #~ .'a <br />~~w <br />YY -. " >t~~"° <br /> <br />~ EF- <br />EFFLUEnI Gn055 YALU REQUIREMENT ~ "~ <br />".. ;~;,~ -`"~" ~ `~ "'' ~~~ <br />~ "' CEFT <br />LC U STA'Ci,E 96PF AC SAMPLE ., r:;r:~ ~°y' •~n• ~.,, ) i.i) <br />P I H F F t! A L[ S MEASUREMENT ~it <br />TAhbG 1 U C PERMR ~ 'ti`~~ ~~ ~ ~~" <br />~ EL' <br />EFF'LUli~1 ~tiC55 YALL REQUIREMENT ;fig __rt~'% ~~ CFF7 <br /> SAMPLE <br /> MEASUREMENT <br /> <br />,, k <br /> REQUIREMENT '.Ai =; "' ~` <br /> ,. <br /> SAMPLE <br /> MEASUREMENT ~ <br /> REQUIREMENT ~??`-•"' " ~ <br />~,; <br /> , <br /> SAMPLE <br /> MEASUREMENT <br /> ."PERMIT :: 4, r ~ <br />., <br /> "REaUTAEM~Ni 2 s' . <br /> SAMPLE <br /> MEASUREMENT °~ <br /> <br /> 'REQUIREMENT ~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> <br />-_,AERMIT <br />{ <br />,p . <br />'~ <br />a.~ <br />- _" <br />t <br />a _ .. * .. <br />- •~ <br />b'r' { <br />t+ 3_ti ,~~,q <br /> E~ <br />~UIREMENT .:• ~'~ l ~ . <br />2 .~ =„s. <br />NAME)11TLE PRINCIPAL EXECUTNE OFFICER 1 CERTFY UNDER PENALTY OF LAW THATI HAVE PERSO <br />T <br />M NALLY E3(AMINED AND <br />N <br />ON TELEPHONE DATE <br /> <br /> <br />~ <br />p~rry <br />~ AM FAMILIAR WI <br />H THE INFOR <br />ATION SUBMITTED HERE <br />INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPON <br />THE INFORMATION <br />I BELIEVE THE SUBMITTED IN ; AND BASED <br />MY <br />I <br />SIBLE FOR OBTAINING <br />FORMATION I$ TRUE <br />- <br />_ <br />, <br />1 , <br />ACCURATE ANO COMPLETE. I AM AWARE THAT TH , <br />ERE ARE SIGNIFICANT <br />T <br /> <br />µ PENALTIES FOfl SUBMITTING FALSE INFORMATION, INCLUDING <br />HE <br />L7 / --II <br />D }~ <br />~ c <br />eI <br />A. N Ir POSSIBILITY OF FlNE AND IMPRISONMENT. SEE 1B U.S.C. 4 1001 AND 33 U.S.C. ~1ATURE F PRINCIPAL FXECUT _ {~ ~ Z.1 / -l <br /> <br />TYPED OR PRINTED g 131 e. (Peneltlea antler rlnlse srarures mey include 5nes up ro E10, WO end w <br />medmum/mpdsonrrem clbeMea06monrN end5yaen.) I'}pFIC R R AUTHORIZED AGENT <br />.~ <br />NUMBER ~ <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell etteohments here) ^, ,,,~, <br />5tE I.A.2, PF 5-7, FCF DETAILS OF TEST PRGCFDURE. fiEFOfiT LC50 - STATISTICAL PCINS EST1!!ATE 4'HICR ]~ <br />LETHAL TC SOE CP TF°_i OR6A)rI585. AND lTTACH ACUTE 7CXICITY TEST REFGRT ECfiR TO ClE. CCF.IES OF All <br />n 9920.1 (DB•95) Previous editionStrlgy 9P) Ua uset•}. ~ (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) PAGE OF <br />a T '... _ 00004,(4~;07a}6,151.1 . , 1 <br />-: <br />.~ _ .. .~:a'Si6.. - ~C's,d..:.BGa --~~'~'t' ' '. r.., i~:Stti rw ~~ ~.c... ,'- ._ <br />