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PERMITTEE NAME/ADDRESS pnclude Faci(iry Nmne/Lomnon ijDiffermt) <br />NAME pICHETYIIIE PROCESSING, LLC <br />ADDRESS NEY ELR LINE <br />1311 B9ENTY000 CRIME <br />FACILITY FYANSYILIE IN 47711 <br />LOCATIOI•lyESTCN CO R1091 <br />ATTlI: AL FERRY, NAttlCEA <br />NATIONAL POLLUTANT DISCHARGE EDMINATION SYSTEM (NPDESJ <br />DISCHARGE MONITORING REPORT (DMA; <br />(1161 (1l- 9) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />Y MO DAY YEAR MO DAY <br />FROM r TO c ? <br />(N} I~ (I4-151 (I6-Ill (I3~I9J (30.31) <br />Form Approved. - <br />!. I N C R OMB No. 2040-0004 <br />Approval expires 05-31-98 <br />(SUER SE) <br />F - FIh1I LA!!AS <br />tlI6E QlIEF. TC A6ACFE CANYON <br />NOTE: Read InsVuctions befor6cor plating thls form. <br /> (3 Card Ony) QUANTITY OR LOADI <br />- ,(4 Cartl Ony) QUANTITY OR CONCENTRATION NQ. FAEOUENC SAMPLE <br />PARAMETER (46.53) (5461) (38-45) 46-53) 54-61) <br />~~ <br />. <br />OF TYPE <br />(~-37J AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS' ~" <br />!, ~~Is <br /> ) (61-6eJ 69-70 <br />PA SAMPLE ~~t#-3 .''.3t=f# ~-'.~~#: ( ~.) <br /> MEASUREMENT <br />O ~ ~ <br />I ~ ~ 4YY I~~ <br />~' <br />EFF <br />LUENT GHOSS VALU ~Ef~ <br />T; •' ~ <br />Y''i~n:'r "+- ~ ~L <br />SOLIDS, TOTAL SAMPLE Y~••Y• ~=%~~~+ ~~+~~y~ I 75) <br />SUSPENDED MEASUREMENT <br /> ' <br />EFFIUENi GROSS YALU ~• EEIT -s ~.g~'r ^ti4d~ ~~".'` ;< ~ "X'_ s~., F6 I C `~` <br />IRGN, TOTAL SAMPLE "Y^'^~~^ •,..-,.,. -•%~+~'~ ( 7S) <br />(AS FE) MEASUREMENT <br />UlU4S 1 0 C `PEg~,,:, <br />" fif 1~ ''~!~ 'a'te ~ <br />~ <br />' <br />'~~ <br />~~ t~'; <br />EFFLUENT G F <br />o S S VALU t~E4UlAEN1~NT ~~'` t ` <br />`` <br />. ~, ",c, ! C I <br />GIL AHL' VFEASE SAMPLE ^•'-'""• T^'+~~v ++ + ~G~# Y-- ( 15) <br /> MEASUREMENT ~ <br /> <br />EFFLUEAI G-F,OSS VAIC AEQUTAEMEN7 "'k ~.' <br />FLCY, I~ CONDUIT GF SAMPLE ( ~3) +•+'++ ~T-i'~.-'•a ~+:%+~ <br />'I'HFU ThIATtlEYT FIAD MEASUREMENT <br />5 L' U S C 1 U C ~' ERMIY~ ~ ~ ~ <br />~ P$8'~,` R$ FO '1' # <br />` ~. t <br />EEFLUE97 GkC55 YALE =f1EQU6iEMENT , <br />• <br />-.~~ `nt`TIi _. !EC ~ - ~~~ ~~ <br />UiL vNl: t; i•EdSE SAMPLE '^'+'~~^'~ ( 94) +++++ v+%+"It% -++~~ <br />VISUAL MEASUREMENT <br />b4Ub6 1 U U 'pERM(T- - ~~ ~: ~'~~ ES=1 `.~~ ~_ ~'~ rI~ <br />w.. <br />Y. <br />r F F I U E :a'P C, R 0 S S VALU ~$EQUIREMENI; ';" `.'~ ~z,`aa~ - ' [~ C = C "i ?° ~+~ "" <br /> SAMPLE <br /> MEASUREMENT <br /> ' PERMIT <br />•' i <br /> <br />` <br />'~ <br /> <br />= <br />~ 6 <br />"' <br />z <br /> <br />= <br />~ <br />r <br /> ~~du~aEMEHr ~ <br />~ f }+' p ~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI FY UNDER PENALTY OF LAW THAT I HAVE PERSO NALLY EXAMINED AND TELEPHONE DATE <br /> AM FAMILIAR WRH THE INFORM ATION SUBMITTED HERE IN; AND BASED ON MY <br /> <br />Q <br />~ <br />L INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATION <br />I BELIEV S IMMEDIATELY RESPON <br />E THE SUBMn-rE0 IN SIBLE FOR OBTAINING <br />FORMATION IS TRUE <br />tr r~l <br />c. <br />- <br />1 , <br />ACCURATE AND COMPLETE. <br />I AM AWARE THAT TH <br />M <br />T , <br />ERE ARE SIGNIFICANT <br />IN <br />D <br />NG THE <br /> <br />- <br /> <br />(~, PENALTIES FOR SUBMITTIN <br />POSSIBILffY OF FINE AND IMPR G FALSE INFOR <br />A <br />ION, <br />I <br />CW <br />ISONMEM. SEE 18 U.S.C. 4 1001 AND 33 U.S.C. <br />S NATURE F PRINCIPAL E%ECUTIV O <br />G (~ ~~ ~„1~,' YyY <br />lam/ <br />v1 <br />TY ED OR PRINTED ~rnumt~~ASlmmerrtarbeMee 6mAOn~entl5utle lures up N 510,000 Bntl w <br />P ireersJ OFFICER RAUTHOR12E0 AGENT NUMRER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (RererenCB ell atteonmBn(5 nBre) <br />3C DAY AYEHAGE I_ H1CEL'ST EIONTBLY AYG. DOAI6G PEAICC REPORTED. CIL E 6BFASF - SEE I.E.1.py, F. S. <br />EPA Form 33261 (OB-95). Previous editions may not be used. (REPLACES EPA 6.OAM T.aD WHICH MAY NOT BE USED,) • -• PAGE OF <br />