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PERMITTEE NAME/ADDRESS Pnclude Faciliry Name/Lomrion i/Di$erenq <br />NAME FICtiET«1nE FFCCF_°SINi;~ LLC <br />ADDRESSN E M e L K P. I V E. <br />Lill rFLNTWCCL CFLVL <br />FACILITY ,.YAh~SIL1i I. 47711 <br />LOCATION i c T C r. <br />~L' Ei0S1 <br />%,: IFI: SL eL86Y. Ci,P1iCEl' <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION <br />DISCNARGE MONITORING REPORT <br />f2-161 <br />- c <br />PERMIT NUMBER Dlsc <br />FROM <br />(2a 251 (25-2~1 <br />(NPDES) Form Approved. <br />` 1 :+C !~ OMB No. 2040-0004 • • <br />. Approval expires OS-31-98 ~ <br />(SGEh SE) <br />1UMBER F- F I A A L ~ L A ii A <br />~cci. AFT .E~TIFC Fc>: ccsA <br />OAY • . <br />~C <br />L:_ChAFCE <br />~~ KKd <br />lsp~3t) NOTE: Read Instructions before completing this form. <br /> !3 Card Ony) QUANTITY OR L (4 Cerd Ony) OU TITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-61j (38-45) (46-53) (59-61) EX OF TYPE <br />(32-37) AVERAGE MAXIMU ITS MINIMUM AVERAGE MAXIMUM UNITS <br />rsz~o) ANALYSIS <br />(64-68) <br />69-70 <br />L I:~U STAI'nL u: !-ii ACL SAMPLE 7~f"'""• ,, r... ..i - t.C,'C~: r... .. ( i?) <br />C ^. it i G ii A P N :+ I A MEASUREMENT <br />7„".;b 1 0 C PEAM4t qA0# aaLL 4 0 :;:: rd 7P < f EF- EL1 FAE <br />:fFLG`•.NT t;i:'U59 }'ALLE REOUIR~f,{ENi :; •:; CEO: <br />~0 ~ A': n:, ytRF ., <br />I - C L <br />SAMPLE 4LOY:2. .:LC:, ~ .'.r,.. t•.;*:, ( :) <br />~ <br />:~ i`: r !' A I f :, MEASUREMENT <br />;F.!+tC i v 0 PERMIT +G-e4G'i ~~' ~ ~ LL'r y"~ ~ + -'~ 0 ]r EF- ~ FLY iA~. <br />cfFI7''h'i :.t.C;°_ rnLL[ AEOOIREMENT :~k'+} -LQ~ (Fal ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .t~~r <br />: ~- - <br /> REQUIREMENT ~ . <br />'~' ~, ~~ <br /> SAMPLE <br /> MEASUREMENT \ <br />~ r <br /> PERMIT ~ ~ ~ 3, -. <br /> REQUIREMENT ""~' ~`' r," -; <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> AEOUIREMENT ~~ ¢~, _. ~- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ` <br /> , <br />REQUIREMENT ~ . (~ ~y~ff»"+-'~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREMENY <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY DNDER PENALTY OF LAW THAT I HAVE PERSO <br />F NALLY E%AMINED AND <br />A <br />B <br />ED <br />N MV TELEPHONE DATE <br /> <br />}>Q , (• ~ AM <br />AMILIAR WITH THE INFORMATION SUBMITTED HERE <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPON <br />THE INFORMATION. I BELIEVE THE SUBMITTED IN IN; <br />AS <br />ND <br />O <br />SIBLE FOR OBTAINING <br />FORMATION IS TRUE : , " <br />J 0 <br /> <br />ACCURATE AND COMPLETE <br />I AM AWARE THAT TH , <br />ERE ARE SIGNIFICANT ~ <br />~ <br />/I <br /> . <br />PE <br />A <br />T <br />E <br />F <br />R <br />BM <br />TT <br />F <br />L <br />E <br />T <br />D <br />N <br />T <br />E /L _ <br /> <br />`"} h , t • Y N <br />L <br />I <br />I <br />ING <br />A <br />INFORMA <br />ION, INCLU <br />I <br />H <br />S <br />O <br />SU <br />S <br />G <br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S.C. 4 1001 AND 33 U S.C. ! <br />g1GNATURE OF PRINCIPAL EXECUTII{E ) <br />'< ( '7 <br />J ~ I'~ ~ ~ I <br />UU <br />0 <br /> <br />TYPED OR PRINTED 5 t3t9. (Penalties untler Mese sretules mey include hoes up rp St0,000 antl or <br />martmum rmpnsonmem plbeM1Veen6mpnlhs entlsyeers.) OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />•.. .. 1.5.;. F1• ",-!~ FC1 L'IAi1:~ Ct .. 'I [~SCCELL~.r, hht:.ri LC 50 - ~'iF.li°_:1CAL iCiA1ctT1PATE ^klCb i_ <br />._.::.;L 7~' ~I;:. :.E 'lt_7 UEL;ANISY15 ANO A'C?ACt AC117: <br />~It:\IC11Y 7E51 F.EkCEi FCF" iC LPF. CCF7F°_ CF PI1 <br /> ~ . <br />~Jt .~f i.e~ V,r-1-CT LL fi,,.R of 1bl <br />EPA Form 332o-1 (OB-95) Previous editions may not be used. {REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) C C C ~ 9 / G C C~ 1 1 - i f ~ C PAGE 1 OF <br />