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PERMITTEE NAME/ADDRESS (Include Fanhn'Name/Gnmrion r/DiBecenq <br />NAME YlCn c'f GI hF FnCC i'S:,ihU. LLC <br />ADDRESS c r i• L k r I N 'r <br />131.i c'.kEB.ir000 GF1Yf: <br />cVA;~-YILlE Ih 47'111 <br />FACILITY <br />LOCATION <br />e:~-: r: !. CC ELC`il <br />1 :':A: r'.I I~. .:.Y• ~.AhAL I:'. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM1 (NPDES) <br />DISCHARlGE MONITORING REPORT (DMRf91 <br />CGC <br />' PERMIT NUMBER DISCRARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ~ l y 70 ~ 6 ~ ~ _ 1 <br />(20-21J (22-21J (2d-Y5) ~;$,., - (16-2]) (19-a9J (3031) <br />Form Approved. <br />M I SC I OMB No. 2040.0004 <br />Approval expires 05-31-98 ~ <br />ISUEri °E) <br />i - iIAAI L~r,A~ <br />FGdCiF 1CnC L/FLIGATCIFErf1cl• <br />-'"~ hC. [ILCF.AFC_ I~ r•'%r <br />NOTE: Read Instructions before completing this form. <br /> (3 Card Ony) QUANTITY OR LOADING (4 b Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-61) (38-45) (46-53) (54-61) EX OF TYPE <br />(32J7J AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />/sz-wl ANALrsls <br />(sa~saJ <br />69-70 <br />F} SAMPLE L~riL•>•.C4 4t CC:1/ :. r.. >,~fi ( :F) <br /> MEASUREMENT <br />.L4UU 1 li (, PERMIT COI '3 'I 'aO# %'':' R- :~ " I F~FIY A5I'iU <br />_tF'LUf.hi :.n0_S YAi[;F REQUIR6MEN7 `;"'? 11IB1~ 4yS;' i)ATICtaY .L <br />~LZ~~, ;CT AL SAMPLE .sr,:-~:,: - .,tt:, >y~;p 1 1 -) <br />', :, F :. ;. l: ?: L MEASUREMENT <br />~b1U C L PERdAIT C +f s>a t,=? <br /> <br />~ <br />~;. C AC t/ FAf <br />tttL~,'•'. '. :I(.U: YdLCt REQUIREMENT ~~` ,AY tX fG/: fCti7k <br />?..LtLSr '•L21 RcLc SAMPLE .., ., ::ti>Y4~:' C ( ~C) <br /> MEASUREMENT <br />;, ~ r.:, i U L PEI3AIlIT a~ "' ' ~ k~ <br />~ <br />' - 4 C A C E/ F A <br />:.rt:;:t.,~i „~aG,S VALi.E REQUIREMENT .~ <br />a=3k:_ <br />.. , <br />_ '.-'!Y~ f1/L fC67r <br />1 .. '.~ ,i: ':AL SAMPLE ': :~r:~-: , .-. <br /> <br />... //I"I .. <br />- ~• U <br />G /~~ I `) <br />(r L t G) MEASUREMENT ~ V ( <br />i; 1 U •1 ;~ i U C PERMIT { '~ L ~' • 1 i• :-,- ?;;~ A C / F A L <br />• trL+:i'~l Ck!CSS YALLi: REQUIREMENT - ~ r'++~'~ 3GCI A46 ~`i~'~t~''iitA' ~ EG/l fCl17t <br />,L A: i; .-I'E;I :: ,, SAMPLE .vu-aM .~ ., ., , <br /> MEASUREMENT <br />J~7b.. I U L PERMIT "' ;. >:, C <br />~ - I <br />l'; <br />~rt; <br />,1 ~bGSS 1'RiCt AEQUIREMENT t'~'+'% '~ ~TMST <br />.~E1` hG/I ),S ~Ti~ <br />. <br />. ,, <br />(,...•, `; ', Ct:NLhi~ Ct SAMPLE 1 ~~ -..•, a,, :, .: ,. .:, i:: :: ,... ,, <br />.. i. ~ c L +~ i .hI h S 1 F L A A'( MEASUREMENT <br />• ,~., ` u 1 G C @ERMIF ~ ~: , aAI ::: ~ 1! AI <br />:F:LdF~1 :~nC.. rFiC[ RfzQUTAEMENT }G~.'A ~, :a1~}''~.~ ls;X fG. •,~r~ <br />:'. ., hM.. 1. l'cASi <br />SAMPLE lY'U Ay ( lq .'•.15'"~' .. .. , <br />Y ::~ ti ;' L MEASUREMENT <br />,.'.( U L' PERMIT - r;+`- FE=] ~~k . i ... -. Y SCi <br />rPi.;%-." CiC55 yALL: REQUTA6MENT <br />L ~~-~ rAX AC=~ "'', ~=,.°- <br />NAMEjfITLE PRINCIPAL IXECUTIYE OFFICER p TELEPHONE <br />B <br />M DATE <br />M FFAMILIAR WRH THE FORM ED ON MY G <br />AT ON SUBMITTED HERE N; AND <br />S <br />INQUIRY OF THOSE INDIVIDUAL <br />//.~ THE INFORMATION, I BELIEV <br />Y~R Yf` <br />' <br />L S IMMEDIATELY RESPONSIBLE FOR OBTAINING ~ ..~ „ /~~ <br />E THE SUBMITTED INFORMATION IS TRUE, Y <br />_ <br />/ <br />t <br />' ACCURATE AND COMPLETE. <br />PENALTIES FOR SUBMITTIN I AM AWARE THAT THERE ARE SIGNIFICANT <br />INCLUDING THE <br />G FALSE INFORMATION <br />/i <br />2 (i <br />'1 <br />~r <br />,1 <br /> <br />)~ , <br />{ <br />I <br />( <br />` <br />_,~Z <br />3 G / 1 O <br />O <br />U ~ <br />k •. 4 ( PDB$IBILITY OF FINE AND IMPR , <br />ISONMENT. SEE 18 U S G § 1001 AND 33 U 5 C. SI} <br />NATURE F PRINCIPAL E%ECUTI E T <br /> <br />TYPED OR PRINTED § 1319. IPenelliec untler Ihese sfe(u(es mey rnclutle lines up ro E10,00n entl ar <br />mexrmum rmpnsonmenl olbefween6monlfs entl5years) j <br />OFFICER OR AUTHORIZED AGENT A <br />C DE NUMBER : YEAR MO DAV <br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS (Reference ell attachments here) <br />1t. ;.r.Y ,Yt4AGt i5 t1Ctn5'i "C h:t'LY AY.';. LUnInG r'.rtr:: Fr_i~IEG. CIL E CFF:.~t - Si@ 1.E.].C• F. 5. 15. t; <br />i~rt6l InC:c: LI".Ii°_ .LIL :-:: 'b6IVF.C, nlii> SF.T~LEAELE °_CI7.~~ LiC.lI5 AFFIIEL FC, <=lOYF~i4MF fFtCIF cYEA':-:::.. <br />:,r llc IfM.TT l-rr or LArusP L't^u llrlVU JIlHt. C[cI'rt L114'~•r-Cii ~1_S ri r' -r - - <br />EPA FOr'm 3320.1 (08-95) Previous editions may not be used (REPLACES EPA FORM T-00 WHICH MAY NOT 8E USED.) C C C O 9 tl C Q ~~~"' FE i C PAGE 1 OF <br />