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PERMITTEE NAME/ADDRESS (Inerude Faclrrry Nome/LocaNOn ifD/Bmmr) <br />NAME dLUP. 'f0UN1.'AL9 t:5S'HGY, IN.. <br />ADDRESSpESEdADO ':INg <br />3607 COUNTY NuAU 65 <br />FACWTY RA!+CCY CJ ~1b4? <br />LOCATION <br />ATf4: JEFF DUH.iP.R'f <br />NATONAL POLLUTANT DISCHARGE EDMINATION SYSTEM (NPDESJ FOrm ApprOVed. <br />DISCHARGE MONITORING REPORT (DMfl) OMB No. 2040-0004 <br />nI\OR <br />r ~ ° r {$U6R .1h) <br />PERMIT NUMBER DISCHARGE NUMBER P _ FINAL R 3 L A ' <br />MONITORING PERIOD %•~ ~ "~~ WET TE$TI46 POR U04 <br />.Y MO ~,,'; ~'~. YEAR MO DAY <br />FROM TO 1 6 3U '~~_` NU DISC~RAAGi: ! '~~'~ <br />NOTE: Read fps uc[bns befo p!eting this form. <br />Y OR LOADING OUAN7ITY OA CONCENTRATION NO. FREOUENC SAMPLE <br />P <br />RAM <br />T EX of TYPE <br />A <br />E <br />ER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS" AwY'vSrS <br />LCSU STATRt;,utlNH .A C' SAMPLE ; oaaaa ra~x>ratra =::~:~.^* ct~+)r:nr;: ( 23). <br />E Ft ~ J D A P N Y I A MEASUREMENT <br />TA'1.f 6 1 U U ring t;;,- <br />EF'PLUE9T GHOSS YALU ~ ~ 't >~''-~ ^~• <br />LCSU STAfRE: 96NR AC SAMPLE +-Yri03a nar.aac traara~z;r a„:ztrr:~ { 23) <br />Pi`1EPriALES MEASUREMENT <br />TANb~ 1 U U !-*~~ Ek- <br />IiFFLL'F.(+T GROSS YALU cagra .,;,,~•,- -:~4,. Cr;•y^ <br /> SAMPLE <br /> <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />prepazetl under my tlirecibn ar edpen3slpil In accordance wRh a system tlesignetl <br />SGO G/~ yls Wessure lhet Walieetl personnel propeRygather and evaluate the lnlormadon ~ <br />submitted. Besetl on rm InquYy M the person or pereonawfio manage the system. ~i y <br />or Toae persons dlRttly raeponalbb for paNenng the Inlormadon, Ne inbnnatlon -/ 7~ / /5~3~ <br />~' `~ j (~~ ~{ 1 aubmittetl la , to the best or my knowledge and belial, hue, aaurete, end complete. SIGNATURE OF PRINCIPAL E7rECUT1YE F7 .J U7 ~, <br />'fYPEDO PRINTED lam aware lnat them era slgnlTtAfJt penalties for submming false inbrmetlon, OFFICER OR AUTHORQED AGENT NUMBER YEAR MO DAY <br />bcludin the si of Rne eAd kn rlsonmem br knowin vlolatioru. <br />COMMENTS AND EXPLANA710N OF ANY VIOLATIONS (Re/en:nc@ all attachments here) <br />.i E; li PART I. H. 3, P~ VLI1, FOK DETAILS DF TEST PR~OC E:~L!3E. 3EPORT LC~U - 5?AT[STICAL POINT ESTIMATE NNICN <br />IS LETNAL TJ SU%. OF TE57 ORGANISMS, AND ATTA^_N 11C11?s TOa7CITI fFST iicPOP.T F~R!1 TO DtlR. COPIES OF ALL <br />A or Prevt us'e ifions maybe IS I A a-PART FORM PAGE OF <br />_. ~ Do~.3~~~~?:~sa I <br />