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PERMITTEE NAME/ADDRESS Onctude Facili(v NumelLocation ijDifferem)
<br />NAME riCE,cT4.Lti:F Fi~CCF`~.'7pt;, LLC
<br />ADDRESSlI F. w ~ L't 7I ti L'
<br />1JII Ii4F.AT~CCC LFIY~
<br />FACILITY LY AtiSViL1 F. Ih 47711
<br />LOCATION.
<br />.E.3'fCF CC r1C''±i
<br />i, 'iTH: kL c~hY, rA Ni•G e~
<br />NATIONAL POLLUTANT OISOHARGE ELIMINATION SYSTEM (NPOESJ
<br />DISCHA6 GE MONITORING REPORT (pMR;
<br />O7- 9)
<br />1.
<br />PERM iNUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />V R MO DAY Y6Afl MO DAY
<br />FROM ~. TO = =
<br />(22-231 (2425/ (26271 f2B-29/ (30.J1)
<br />Form Approved.
<br />' I A L .`i OMB No. 2040-0004
<br />Approval expires 05-31-98
<br />(SCLii :: E)
<br />I•I :•if '•!7EF YC FLFCJTCIFE FIIIEF
<br />r ~ NOTE: Read Instructions before'c~ilpleting this form.
<br /> (3 Card Ony) QUANTITY OR LO .(4 Cerd Ony) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER (4s-53) (5a-sr) (38-<5) (a6-53) (5a-6tJ EX OF TYPE
<br />(32-37)
<br />AVERAGE
<br />MAXIMUM
<br />UNIT
<br />I~MUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS ANALYSIS
<br /> (6z-63) (64-6R) 69-70
<br />Y :' SAMPLE "' 4'+"~'~ .. >..r ^ ( ~ )
<br /> MEASUREMENT
<br />t; L,iO~ I U C PERMIT -44 fR4 A .! iSe :G:~ y~, ,.-;~-r '~Q1F` s - - ~ 1 FEKIt ASIIU
<br />Li'EL41: !.1 GFC:~L YALUE I~EQUIREMENT ~ :*Y" >~'X~ ~ ~°-~ ffil7(.(t.tC ~L
<br />JLii!S, ~(,'iAL SAMPLE ': r'' ', r, ;: :,: t- q p ( ~)
<br />S C :, F ;; '~ is c B MEASUREMENT
<br />t:' ,1J I 0 C PERMIT fi'v""~ >? :Lx4K•=.: C CE/ F'AE
<br />c,rrLU;:."rT L,RU.°i5 YALCE REE;IUIREMENT r.'. "`w j ~ ~, -~j!~~ -~ FC/L FCA7F
<br />L-c,~, TCThL SAMPLE ~ ..
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<br />(A. F E) MEASUREMENT 1`, I ~ u "
<br />~;UU•, L G U PER~1(T aacacr„ a>nK'~ar, ;gyp:
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<br />LL A. fl l' GHEdSE SAMPLE '. `. "tfifi~fi •t~ >D»~: ( iT)
<br /> MEASUREMENT
<br />~~:T~L 1 G U PERMIT fi ifi'~ CfiK>;i•i: ~ ':~::~ ~ fi+%fifi _ C CISIA fAE
<br />:- r 1. 7 E t.'r L;+.U.'-i S Y A i C t REQUIREMENT ..
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<br />,2~59'C13
<br />FG/L
<br />~hAT
<br />ELCh, Itv CIJNUUI': lF SAMPLE I ~~=) -~~t,%%=> ICCG=? 4i iiGri
<br />~'~ ?' h i. A'I t! d N T F L A ~ 7 MEASUREMENT
<br />• ~•' ' (% D PERMIT ITT'' REFCFT ~-ifia+e
<br />~ 0+00 L EPNLI ASTAb
<br />
<br />;.iLF~.'r L;r.05' VALLE
<br />REQUIREMENT
<br />3~UDA A9G
<br />AxY2y '".Y
<br />PG:~
<br />Ti.r 4-* k.3
<br />C6rC
<br />. .i ., ..",C ;h6A5E SAMPLE •,.. `O I Sq) ., ..:? :;:,t., t~r;tLQd
<br />~ -, u n L MEASUREMENT
<br />,. I. ,, !;c . U C PERMIT t4L~6r?0 *' CA
<br />- EE=I ~+Cai~: Sii ~C Yit =; ~ IY ]54AL
<br />,.rFLStS: .•riU.°+5 VALCE REQUIREMENT .,.;
<br />~',ltAY AC=C r ~;;
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT ~': }': ; ,.'='~ ~
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<br /> REQUIREMENT ,, ,~_~
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<br />NAME/rITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND
<br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN
<br />AND BASED ON MY TELEPHONE DATE
<br /> ; ~
<br />A
<br />L . 1/ ¢ r ~ `` INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING
<br />THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMATION IS TRUE, `` ;^ '
<br />\ y
<br />
<br />ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIGNIFICANT .
<br />A K
<br />
<br />PENALTIES FOR SUBMITTING FALSE INFORMATION
<br />INCLUDING THE ~~
<br />~
<br />
<br />M " '~ r' ' F. { ,
<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 18 U.S C. 4 1001 AND 33 U.S.C. y
<br />ISIGNATUdE OF PRINCIPAL EXECUTIVE p
<br />D 1~ (,/-r y
<br />O b I ' -I 1 Zl
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<br />TYPED OR PRINTED § 1319. (Penalties under these sfelules may include lures up to 9t0,OG0 end or
<br />marimum rmpnsnnmam olbehveen6months end5yeersJ OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a/I attachments here)
<br />.. ~~Yr.Vcr.ALE LS t;ICkESI i`:iFTFLY AYJ. DUFIEG i-tFICC h=.iCFTf.C. CIL ± LfEP~r. - !: ..i..I.I, i. 5.
<br />EPA Form 3320-1 (08-95) Previous editipns rRay noF~~b~¢¢USed. (REPLACES EPA FOf)M T-40 WHICH MAY NOT BE USED.) C G L C I / C C h I 1 l - 1 C i C PAGE 1 OF
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