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PERMITTEE NAME/ADDRESS Qnclude Facilin~ NamrlCorouon jDlBerenq <br />NAME 1ICrhTMIhE FFCCE:_Ihi„ LLC. <br />ADDRESSy 1 w ;. L K N I K E <br />i?11 L'FCNI MCCL CFIYE <br />EJ:4VS'l1LLI. IK 47711 <br />FACILITY <br />LOCATION ` ~ T J <br />CC A.1L91 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMA) <br />f2~161 (I]-19J <br />PERMIT NUMBER DI$CHARGENUMBER <br />MONITORING PEd10D <br />YEAR MO DAV V MO DAY <br />FROM •% I~1 1 TO - - ' <br />(20.11) (2229) (2d-251 f161]1 l2B.291 (90-91J <br />Form Approved. •" <br />N i eI C n OMB No. 20400004 <br />Approval expires 05-31-98 4 <br />(SUi:F SE) <br />F - EIt,Al IAiF~ <br />ACJ",~• wE1 '[ES1lDG ECF CCIA <br />'' :.~ Li::~~'r.eFCt ~ tkr <br />NOTE: Read Instructions before completing this form. <br /> (3 Card 0 <br />QUANTITY OR LOADING <br />) (4 Card Ony) ~ tlANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER 65 <br />3 <br />( ) (5461) (39-45) (4653) (54-61J EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> fs16TJ (64-6a) 69-70 <br />L(.SJ :i'l Al FE IIBE~b ACL SAMPLE '~~``~~'~ CC4O ~~~;'~'%`( 'r'•'~ ~^ 1 <:) <br />C Lr: I G i, f. i~ H .. I A MEASUREMENT <br /> <br />C.;C±[- 1 U L PERMIT i ~ _~~ ~ rs 3 ~ S r' cF- ~ 7 LY FAI <br />~eFLU[N1 ~FCS_ YALLE REQUIREMENT - - t;~4.''w .""~" '`~,~~ CcT•l <br />LChv 1+Thi?.. 4L~'. S5 ACL <br />SAMPLE n=X: a•a*.: I; r, r, a. ,µ . <br />Li9 ~{~ <br />is t,;:;., <br />( ~:) <br />- <br />e .[ 7r i' .: A L ~ `i MEASUREMENT <br />i i~ f. 1, 1. 1 :1 U PERMIT L• C 4 ': 4' r: F° ' t - 1; T F 1 F A Y <br />:.rFLUc.::1 CI+C:it YALLF flEQUIREMENT ~~~%+~ CM yAjUE CEA': <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~'' '~` <br />~ ~- - <br /> REQUIREMENT ';,~:"_ '~' i~`•::' ~ <br />'~ - <br /> SAMPLE ` <br /> <br />MEASUREMENT '~ <br /> PERMIT- (~ <br /> REQUIpEMENT <br />., - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ -~ - <br /> AEQUIREMENT <br />a <br />~' !' - *-`" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ "-~'~2"•'~- <br />- <br /> REQUIREMENT - . - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - - <br />~ - ~:~ '~^~ - <br /> REQUIREMENT ~ ~ <br />' <br />" <br /> , <br />~, -,... <br />~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED ANO <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN <br />SED ON MY <br />AND B TELEPHONE DATE <br />``,, <br />C <br />L <br />~ <br />A ; <br />A <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />THE INFORMATION <br />1 eEUEVE THE SUBMITTED INFORMATION IS TRUE ~ <br />` <br />f <br />. <br />, <br />! . <br />. <br />ACCURATE AND COMPLETE <br />1 AM AWARE THAT THERE ARE SIGNIFICANT ~ <br />• <br /> <br />. <br />PENALTIES FOR SUBMTfTING FALSE INFORMATION <br />INCLUDING THE '~7~ <br /> <br />M A M ~ ! . <br />POSSIBILITY OF FINE AND IMPRISONMEM. SEE 18 U.S C 4 1001 AND 93 U.S.C. <br />$ NATURE <br />F PRINCIPAL EXECUTIVE ~j <br />D (L G 'I <br />D ~ 1'11L1 <br />(~ <br />V ~ <br />U S <br /> <br />TYPED OR PRINTED § 1319. (Penetties under these slelules mey include hoes up to E10.000 and or <br />maximum impnsonmera of beNveen6mwrths ends years <br />) OFFICER OR AllTMORIZED AGENT AR <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . ODE <br />L.vmin~rv+ o rrrvu uruanrc I +urv yr tsn r nLn1T I Iona Ircererence en anacnments nere/ <br />-.. I.A.;, Fe S-7, EC: ...:r.I1~ CF 'li5Y FFCCECUl+F. .,..:11 LCSL' - STATI STICAL rCIlI E.7IPAlE iIFICr, 1. <br />Lt'ii:9L iC ~C.. CE TE_'. <br />L/~Gn}15[^~, AIiC AT1'ACk ACUlE TC3~C'I7Y Tc$T hL•}CFI Ff,F!! TC LFF. CCFII~ CF AI[ <br />~. L'!+[: Y e•r -E ~ M t <br />r IT ¢ F ~ C• 11T BF& <br />EPA Form 3320-1 (08-9$) Previous editions may not be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) ~ QQ C C S / G C C~ I 1 - S 6 e C PAGE 1 OF <br />