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PERMITTEE NAME/ADDRESS ((nc(rd¢Faciliry Name/Locp(ion iJDifferrnQ
<br />NAME
<br />'1I'~KF,C, INC.
<br />ADDRESSNOHTN THUNPSON CRFEK ~I,VF.S
<br />2768 ~ONPASS DRIVE, ;IiITF. IU'.
<br />FACWTY oAAND JUNCT IUN ,:,( !~,,,
<br />LOCATION.ARhUNDALE ;;~ ,] ~~; I
<br />AIL'!: J. f. 520Y °.R, C~Y3[I L'1'I:IG :.G.
<br />NA7IDNAL POLLUfANr DISCHARGE ELIMINATION SYSTEM (NPDES/
<br />pISDHARGE MONITORING REPORT (DMR)
<br />rn. +>ti' n
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEA MO DAY
<br />FROM I ~t I ~ U': ~ _' 3 1
<br />Form Approved.
<br />OMB No. 2040-0004
<br />NINON
<br />(5:1%i^ WC)
<br />f - CIHAL
<br />'~;'~= T-~ZvItiG RtINOFF ~E'LI PON:;
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<br />NOTE: Read Instructions befotB~mpleting this form.
<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE
<br />PARAMETER ' EX OF TYPE
<br /> AVERAGE MAXIMUM UNITS: MINIMUM AVERAGE MAXIMUM UNITS /~-ys/S
<br />N:r SAMPLE St4R9t 9tR 3: #r-':# ... .. :
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<br />~' MEASUREMENT
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<br />EPFLUENP GRO55 VALU
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<br />AIL E GREASE SAMPLE :.. _ :..Ah n
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<br /> MEASUREMENT
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<br />DUDS, TOTAL SAMPLE .. .. - .. ( L~)
<br />U I i 5 0 L Y E U MEASUREMENT
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<br />U1L AND GREASE SAMPLE ^. ~. ( '~i) :... .'.: ;: r-'~': `•#####
<br />V 1~ U A L MEASUREMENT
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<br /> SAMPLE
<br /> MEASUREMENT
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<br />
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CerLy under penalry of law that mis tlocument and ell edachments were TELEPHONE DATE
<br />I preparetl untler my tliraction or supervision in accordance wile a system tlesignetl
<br />I ~ , S~ Jr-~l
<br />,`~ V'"~ to azsure that qualified personnel properly gather and evaluate the iMOrmalion
<br /> submitled. Bayed on my inquiry of lha person or persons who manage the system. ,~--
<br /> or (hose persons direnly responsible br gathering the iMOrmetlon
<br />the Inbrmedon
<br />t/~ ,
<br />aubminetl is, to the best of my knowledge end belies, tme, accurate, and tomplata. ~ SIGNATURE OF PRINCIPAL EXECUTIVE Z S ~~ ~ ~ U
<br />
<br />TYPED OR PRINTED I am aware Iha[ there are significant penalties for submiding salsa inbnnation,
<br />Mcludin the sibili of fine and im risonment for knowin violations
<br />OFFICER OR AUTHORIZED AGENT
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />GUNMEN 15 ANU tJ(YLANA I ION Uh ANY VIOLA I IONS (HelerenCe all a(faChmenlS here)
<br />S~fTLEABLE SJLZDS LINIf GILL CE GAINED h'Od >10-YR, 2u-~{R PKECIF F.VEIiT-Sf:E I.A.2, PC IV, FUR REQUIH::CFt~T:;.
<br />1HfKLY SAMPLING LNSTRUCT.I6N:i-I.C.9, PG IX. .iU DAY .4VG IC; HIGH~~T bUN'THL~ AVG DURING PERIf~D REPORTFU.
<br />EPA Form 3320-t (REV 3/99) Previous editions may be used. THIS I A PART FORM PAGE OF
<br />..,". .. _. ...,.t.,. .: U..J~gL~04A71I1-1~3~ 1
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