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VERMITTEE NAMEIADDRESS R. ~1. Fsu,ryN,w/Iaulm IJDId..m) <br />NAME gylEg;;y FpgLS !IININo CDhPAFY <br />AoDRESSSUUTHFI%LO SINE CJAL LUADJUT <br />35G INDIANA STREF.~, ;UITE COu <br />GJLuth CJ 8G4D1 <br />FACILITY <br />LocAnoFlp L J d i ~I C P. C J 812 2 6 <br />ATTH: uEJK~E Y, 'rAITEPSJN, ;1!I. nsd. <br />NATIONAL POLLUTMT DISCHMOE ELIMINATION SYSTEM ///PDE$l <br />DISCHARGE MONITORING REPORT IOMRI <br />1-I al 17-19 <br />CO„DSDUGS Gut <br />PERMIT NUMBER DISCHMGE NUMBDf <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM U lU U TO U U 12 3 <br />116111 l11-131 11415/ 11617/ l18-191 136311 <br />Form Approved. <br />POND 2 DSCN RG '^p OM~No: 20L40-0004 <br />(SCIPR iE) Approv ie~i~~05-31-98 <br />F - FINAL <br />"It:OP, <br />turf '.D DI iCUADCE ~~~ ?~. C• <br />NOTE: Reed Inetruetlone baton eompletln0 this form. <br />PARAMETER 13 Grd On/yl QUANTITY OR LOADING 11 GN Onlyl QUANTITY OR CONCENTRATION NG FREQUENCY SAMPLE <br /> !16531 154511 /39451 /I5-531 151-511 DF <br />131-371 EX MALrsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 1a1~a~1 (54581 159-701 <br />~H SAMPLE u44C44 4:Y4}h# <br />~-fr" ~-~t <br />( ~ ,~ <br /> MEASUREMENT <br />)U4JU 1 U D PERMIT 'x~~~'q~y: . ~OtC+RIkO.:al o#4 y,g . ..: .. ~C4# +y 9:0 S E!!S~ ITO <br />F <br />S <br />cFF'LU:Y'i JPOSS 'lALUE REQUIREMENT : d#74 fllyj[4lfitl <br />~ ftAYSRFI*S: :.'I °i::: ; <br />. <br />:.. <br />3DLIDS, ~I.TTLEA~LE. SAMPLE ~}40#G'# 4#a4a# 40###+} / <br />n <br />l` t <br />~ ( c~ <br /> MEASUREMENT ~ _ ~ ~ <br />~1 <br />k <br />~~ <br />- ----_ ~ __ <br /> I <br />S <br />. . <br />)US4S i G D ':. PERMIT,..:: ,GG91 A!yI:IIL':: :.: :::.tXOldxsk tk .A 490 '~:: '«QI1I LA.IL~.:; e ::..... .~:!~~ 4'::":'T:': ~"~>". ~4 ~~.:-1 ~.~~8 <br />:PFLULcIT ,;1~.0i5 YALUE :REQUIREMENT .. ::: .:':::::;: ?.::::.:::::' tpr~00 ML/r <br />)IL AAU .; r:EASE SAMPLE #471400 a:za 440 IY#4'#{t rt #I!# #r. ( ? ~~ <br /> MEASUREMENT <br />i3Se1 1 D G ;. PERMIT .. 4Gr=ORR .: OG74.40 A1 4S'+1 p.CFq off Y1' S+Oi's+R ~ <br /> <br />..: <br />.. <br />... <br />. <br /> <br />I <br /> <br /> <br />pt <br />XNI <br />4'~~Q <br />iFFLUtNI " <br />.,aU$S YALUE <br />.RE¢UIREMENT <br />4040 <br />. <br />. <br />. <br />DAILY. Ffk' <br />r,G/L <br />~FN? <br />FLDY, It CDNDUIT DP. SAMPLE ( p3j 4ia44c 4t-# 3cl 4##4#r: <br />CHF1U TREA rneNr FLA NT MEASUREMENT <br />f00SU 1 J 0 .. PERMIT ... IPTI1IFk.f. RF4UR2 b#;c4tiYL L'#+:r ~y Tsky1!/,i#sk ; rv.::~x r FFCEIC : :NSIAS <br />:PFLUEI~1' ;PUSS YALUE ;REnularMENT .3:DD.A.::AL.G dAiLY !!k CCD :., ~ FtON'~FF <br />)1L AkU ;;:cP.ASE SAMPLE #b0043 ( 74) 4;; Its:;; r.:~; ~:~;#;:,;: <br />l I 5 it A L MEASUREMENT <br />. <br />fu0bb i G U ~.. ~ PERMIT.. ~.~.~ .~~ #Qrp~0~R 0.~ <br />~ <br />~ tIEPURT Y E5=1 4k.::9~p4 ~!krtG'=~ >:r :--.•. •~.... ~ ~ CFA <br />L <br />:Ff'LIJ f;N1 ;;ROSS YALU° .IiEQU1REAAEflL ~. I'IfST '.l A~%~ NO=U :~ .. ...: (".~....: ~. ~.. ~ ~ ...::.•-;: r?F <br />• p g: ::: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT.:-.. <br />~., .: . <br />:. ~~ <br /> :REQUIREMENT. <br />...:. ~. <br />.:. ~:.... :. .. ~ .: ' <br /> SAMPLE <br /> MEASUREMENT <br /> ~. .:PERMIT ~:~ ~ ~ .: ~ .. . <br />~ <br /> REQUIREMENT: <br />:., .~.. ~ :. .:.~... :.:. .. ~ <br />_ ~ . <br />NAME/T1TLE PRINCIPAL E7(ECUTNE OFFICER I CERTIFY UNDER PENALTY OF UW THAT I HAVE PERSONN.IY E%AMINED MD <br />AM FAMIUM WITH THE INFORMATION SUBMITTED HEREIN: MD BASED ON TELEPHONE DATE <br />/ ~ ~ ~y• iSr-TrL <br />J ~.% Yl <br />/C MY INQUIRY OF THOSE INDIVIDUILLS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNINO THE INFORMATION <br />I BELIEVE THE SUBMITTED INFORMATION IS <br />_ , <br />TRUE <br />ACCUMTE MD COMRETE <br />I AM AWME TNAT THERE ME I / <br /> <br />~ <br />J , <br />. <br />SIGNIFICMT PENALTIES FOR SUBMITTING FAISE INFORMATION <br />INCLUDING <br />~ ` ^~f-f~ ~'' ~ ~-'-'`-"-l- / i <br />- 7t' <br />/ <br />'± <br />~ <br />~~~/( `, ~' / C_/ I n V L~ . <br />THE POSSIBILITY OF FNE MD IMPNSONMENT, SEE 18 U.S.C. ! 1001 MO ]3 , <br />BIGNATURE OF PRINCIPAL EXECUT (/ / ~ ~ )rte 1 <br />G! ~ <br />- f ~ <br />~ J <br /> <br />TYPED OR PRINTED U.S.C. f t]tG. IPrWe„ t,MA• ewr ,rottm..I.r ichra, lirw. ~ ro 510,000 <br />Ala nrmumvn inpivnwN el MrwwnamanaraW aFwral NE <br />OFFICER OR AUTHORIZED AGENT <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAV <br />L.ummcn I a nnu cnrl.++nn I wn yr nn i Ylvcn I wn~ Ins, erenctr mr euacnmm~u nerrr <br />SETTLiAaL:: SJLIDS LiCIi eAIVEU FDR 1U-YP., 24-HH PRECIP EYFaT bUoJECT LU .7Ji'' ~:: ,^ F•~IGF' Rc~;!):k1'M:',- Z!f <br />PAkI I. d. i. D, Pte. 5. STURMeATEft .".A9Ai,E!fE:NT PLA9 DUY. 1-1-9p. <br />EPA Form 3320.1 108-951 Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.) PAGE 1 OF <br />