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PERMITTEE NAME/ADDRESS (include Fanhly NamelLnrarion fDi$erentl <br />NAME FICE;tTJIFE FFC~E°SIhG, LLB <br />ADDRESSN L L ~ L K C 1 ti E <br />1311 i;kkhi4CCC C}IYE <br />EYAY°_Y?LLE Ih 47711 <br />FACILITY <br />LOCATION.., , <br />a;._1Ch CC ?1191 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR~ <br />(2-16) (Il~ 9) <br />~'! <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING P D <br />YEAR MO DAY fk' MO DAY <br />FROM ~ u ~ J <br />/aOJll J99.991 t9a-Ja /9F.9>I nHd91 1.90.911 <br />Form Approved, <br />= I h C t, OM8 No. 2040-0004 - <br />Approval expires OS-31-98 ` <br />t~UEF _°Ej <br />[ - fIRAI lir.A; <br />rIvk 6A7r.F TC iFFCkE CA~YCh <br />' r NOTE: Read Instructions before completing this form. <br /> (3 Cerd Onty) QUANTITY OR LOAbIFE (4 CeN Onty) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (46-53) (54-61) (38-45) (46.53) (54.61) EX OF TYPE <br />(32-37) AVERAGE MAXIMUM UNITS MINIMUM ~ AVERAGE MAXIMUM UNITS <br />(62631 ANaLYSts <br />(64-66) <br />69-70 <br />+~- SAMPLE +'4::~;t.} .,4r,. ~, ,. ~O Q>D .50 ( :.) <br /> MEASUREMENT <br />~~C4U0 1 U U PERMIT ~`~~ ~.:~ - $ '`•~'~ E... ~ *~ - EEhIY, A511U <br />t.EYLUhT GHC55 YALLk RE'QUIRRMEN7 ~ =`',z t~nT -"':,. 44~i~ dIhICUN ~ _ , <br />•;{1"#~$~61 :L <br />'_'LiL'~, ?CTRL SAMPLE +C%~4G~[+ 90 Ofi .-."+=+-'.' ( i5) <br />.i >. P L' :4 L k L MEASUREMENT <br />u'~ 1(i 1 G G PERMIT Y)161tr9 oaso»a ltc. ~ac>GOIo 3 G CE/ EAE ' <br />i..`PLL';. `•T L[yOSS YAlUk REQUIREMENT ', SC~:~ 3GD~ ,py6 Qjjtp !']~ NC/1 4?1k <br />i. t: ;;S, TGIdL SAMPLE '.'Yt::; ::::. .. .. ... ( :~~ <br />(n .; ~ ~~ ~ MEASUREMENT <br />-: UU`~ i J U PERMIT ?t!r•rr~4 gU.ofitt t; '-. ~:~ #Y~>, try .; L`[/ E$L <br />L`'F Ll,~'r.`~T i:H055 YnLUE REQUIREMENT ~ ~r <br />~G~{, 9lY A.ILY 8k rG/L -f1~7k <br />.•:1 A.h C'- GFEASE SAMPLE ..... .. - i\ <br />V ~'.. ~::' .:; :: _: ',-, ~ ]'i) <br /> MEASUREMENT <br />t, ,; ~+.'.'. 1 U U PERMIT. Dp+P irCA D4KAi+w 4 =': ': %.'+i •^. %~s~ 9>Stl~+G~ G f kS,Ik EAE". <br />r.: F:.u t. ~"i Uit055 VALUE AEOUIREMENT ~ Ilh3T, !RY <br />. FC/1 Ei4 <br />I L.. ,., h COKDGI? CF SAMPLE 1 _ ',) _: :: .. .. .. .., ~{<v%t~ <br />T I' .: ~' T'•, c, i T M E h T 1' L b D l MEASUREMENT <br />_-L~`.:/ 1 U U PERMIT 6f EC!F.T FECCkR w Cm A><CL'4A dd0i#0 4%: .,r.,.. <br />~ E$ Y~ #G1A1G <br />,r Piue~IT Sk055 V;LCC REQUIREMENfi 3CaA 11'~G DAILY !$ ?C.. %>;~t ~_~~.;''- <br />... n6:: Cti:,ASF SAMPLE ( 4) .. .... .. ., .. 4;%:t, <br />V : 5 U := L MEASUREMENT <br />:~~1 tiJb a V C PERMIT LOO=9;`t1- FI :.'ECHT E`~=i AOfi40 OAL'AC Vi4 ii iyS ±":y '$I11 15LA <br />•`}L'Jt'•i GkCS`_ Y.4IUE REQUIREMENT I6°1 F1A$ 'C=C' ^'~"'+ ._;, ~~~ <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT ~ <br />NAME/TITLE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E%AMINED AND TELEPHONE <br />AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON MY DATE <br />INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING V <br />~ ~ 'y <br />1 BELIEVE THE SUBMITTED INFORMATION IS TRUE <br />THE INFORMATION <br />~ <br />, <br />~ <br />~ ~ T y <br />. <br />L <br />I AM AWARE THAT THERE ARE SIGNIFICANT ti M1 <br />ACCURATE AND COMPLETE <br />' <br />G <br />. <br />PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE /r1 6~~ ~Z <br />i ~ POSSIBILITY OF FINE AND IMPRISONMEM. SEE 18 U.S C. 4 1001 AND 33 U S.C. 'SIGNATURE OF PRINCIPAL E%ECUTIVE DD ~ O ~ <br />M h H ( <br />~V 0~ !' <br />V <br />, ines upro510,000 entl or <br />U <br />l <br />~ <br />l <br />M 1 <br />THORIZED AGENT <br />OR <br />TYPED OA PRINTED ~S <br />months end S <br />meximum <br />mpns <br />onmem of <br />5ehvee ~6 OFFICER <br />AU <br />C NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reverence all attecnmenfs Here) <br />i, C6Y nVkr.4Gt. I. F]Cf=Si c~'.`+'~~.iY AYG. Cpnib~~ I~~~::~ .._FCFrFL. i.ll C~ 6hFP~: - REF Z.k.].I. }. 5. <br />EPA Form 3320.1 (OS-95) Previous editions may no[ be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />CGG25/CQ ~i-1[et 1 <br />