|
PERMITTEE NAME/ADDRESS (1nfrAlFrWryNA+/(.K.flq 7JD~LwN)
<br />NAME '~iAn ~.l)AL (:UdeAilY
<br />ADDRESS BEAn NUi j tllHt
<br />e.o. aox 518
<br />sodeasEt
<br />;.v b1434
<br />FACa1Tr
<br />LocnnoN
<br />dTTN: DAYIBj, dtsA, t1IFc 4AMAi.::ii
<br />Form Approved.
<br />uUNOt'k TV b Fi, G~~~~~i~iT98
<br />(SUdH ii C)
<br />F - FINAL
<br />nINOA
<br />~~+~ nG LISCHA6GE ~ an#
<br />NOTE: Reed InatruetleNr bafar.~ olnp tiny thb form.
<br />PARAMETER 13 Qrd Onlyl OUANTfTY OR LOADING ~. nlYl GUANTITY OR CONCENTRAt10N NO, FREOUENCr SAMPLE
<br />13I
<br />37/ rOG53/ 15L51/ 38.151 16-53 l5I-51
<br />EX OF
<br />NALrss
<br />TYPE
<br />- AVERAGE MAXIMUM NI NIMUM AVERAGE MAXIMUM UNITS az-sal A
<br />15A-5g) 166701
<br />1A SAMPLE ii##076 0:}OL'O:~ . -: v#0v ( IZ k.
<br /> MEASUREMENT
<br /> .~TI~:.. ;:r: ~•:<::...~yti.+9liAf;
<br />~i(.
<br />:, :...~,.,,::.:s~:;:
<br />~~~`
<br />: >~ ItYYAYi.~~:
<br />>:;:; 1:4~ ~:,' l~S$;K~::. ;~:t~}~SI~Y~
<br />tE: LUnHT L:H0S5 YALU .;EnUIHEMENT. ` .::<. ;:;:..;,•. ;;,,;: .
<br />.
<br />:::r::.;-:.:':-i:;<':'
<br />.. ..
<br />.... AGE:: ...
<br />.
<br />~ ~ .
<br />~
<br />~.
<br />SCL1D5, 'IO'TJj,
<br />SAMPLE
<br />AYeO*'
<br />f+.'FV~>1
<br />T
<br />apt
<br />~
<br />( I9
<br />~ U ~ F E M D E (i ~ MEASUREMENT " ~' ~ ~ ~
<br /> M~8/. 6f~~8:
<br />EEELUEYT GH05S YALU
<br />,...
<br />r
<br />SG..iDS, >>3T2r£A~,.E SAMPLE •. itA#7{+ r'+~~o: #q ~,,' ' 'tflClpiAA: ( 25
<br /> MEASUREMENT ~ - CJ
<br />U~S4S I O 0 ;. PERMIT .: ; -:'; ::.. < .:;;
<br />"
<br />~ ?';.':': /71>OIYd1-Ytii3. 4'}y ~A#~,..:: :.A."
<br />... r::::;."'~~MQ~:'~; ~.~~~ ,..: ltS:
<br />cEFLUEMT GROSS YLLU EQUIREMENT ~i X;:}{,~ ~.
<br />^r
<br />- ~H RL L
<br />IAOY, TOTAL SAMPLE A I-+SA### 4~=###;~ ( I9
<br />(A5 F$) MEASUREMENT
<br />..
<br />•
<br />UlU4S 1 0 U t:::
<br />:PFRMIT:~. .. ~ " ~
<br />., ~ . ....:.'.. .
<br />Lt•r.u~H, Gwoss r~LU .
<br />,....:
<br />GIL AND GeHASE SAMPLE #Ye00!Illx. +- IJO##YA4 7vv#r::: os~##d~} ( 19)
<br /> MEASUREMEN T
<br />.,
<br />` ~ ~.~
<br />u 35b2 1 0•. 0 ..;PEREAiT
<br />: 4 IR#
<br />.~' :'~,:i :
<br />:'k :
<br />.
<br />: At4>r ''4+/tiir#;FtC ri~+i*'+91## . . j:{~::. `, ::~`'~.
<br />.
<br />. :...~.~ :'
<br />tFFLUENT GH0~5 YALU ..
<br />EOUIREMENT
<br />.,.;..,.,, .
<br />......; .
<br />...:...:
<br />:.
<br />.
<br />.` s
<br />,<±~'~4:i::;1<,.::.:,,:`~
<br />#A#~e
<br />~. ~
<br />~- ~ ~ ....
<br />::INS ~; .$la.:
<br />tlG/ L
<br />; :,:;:
<br />,.
<br /><.:d+`:::I(~.
<br />~::;:.:: ~~::~.:
<br />FLi)ir, IN UIT OH SAMPLE ( G3) VA#>k4-: a#ACS}A ~a;eur,
<br />.iiitU iHEA'irEM'L' e..AN EASUREMENT
<br />SLli50 I O O ;..: PERMIT:'::.... . :.: I~
<br />PA
<br />~
<br />;, ',<:
<br />., Q$i'#~+6 #A&#ai'?d1 ?O:iR:.. f+414:: ##L ~,.. '
<br />:: ~:.:~~+~'
<br />
<br />BEYLU£NI GH'0~5 VALU
<br />....EduLREM..ENT. .
<br />,.
<br />3t~.1G`:::~. .
<br />..
<br />:
<br />~"z91~:
<br />tlGD
<br />#ala#
<br />'..` .
<br />::: .:;..:
<br />
<br />::: ;,
<br />S, 0 ~ SAMPLE ## # ~^ r.~~-. ( I )
<br />UI350LYHD MEASUREMENT ~ -
<br />7G295 1 0 O ':r:P
<br />MkT::.:::~. ::~
<br />~ ..
<br />....:::::
<br />:
<br />;,~'{r : o;:L .: -': ;J;:::S , R'T;::;:.:;;;.;R:b°.0.:~..
<br />,,
<br />. ;~ .....:
<br />..
<br />L}YLUENT Gtl035 V'ALO Egu EM .
<br />„ .
<br />.
<br />.
<br />:
<br />~; -#A40 .
<br />.
<br />.~ ~:~3.iiAA 1"VG ~>3~I:~~ .~dl~. NG/L
<br />NAME/TITIEPRINCIPAl EXECUTIVEI>.FFICER 7 cERTe FYUNDERPMALTYOFL
<br />~
<br />AY7rTHA'E/ VEPER58
<br />~l NALLYEXAMI
<br />ER
<br />ND NEDAND ~ i /~ TELEPHONE
<br />ABED OM ' DATE
<br /> AM FAMILIAn WITH THE INFO
<br />INO
<br />IEV OP THOSE IN
<br />M NBMATIpN B
<br />f
<br />AITTED H
<br />DIVIDVAI€ IMMEDIATE EIN; A
<br />e
<br />Lr 11ESPON51l LE FOR ~
<br />/
<br />L~ „` I 1_ n
<br />~ i ~A IL- y
<br />U
<br />0 TAININD 1NE INFORMATION
<br />D , I BELIEVE THE SUBMI TTED INFOMI ATION 19
<br />R /
<br />~ /"
<br />
<br />' UE, AGCUMTE JWO COM
<br />TA
<br />T RETE. 1 AM AWMM
<br />F E THAT THE
<br />ATION
<br />IN
<br />R E ME
<br />CLUDING
<br />~
<br />i
<br />~r ~, nr ~~-~ SIGNIFICANT PEHAL
<br />IEB FOR SUBMITTING FALSE IN
<br />,
<br />O
<br />M ~:
<br />~
<br /> THE POBSIBILITr OF RNE AND I MPRISONMENT. SEE 10 U.BB.C. E 7007 NAt+1D T
<br />'
<br /> u.s.c. E rata. tl4WM• urr eMr mroro. mry hc,Y.W 6,r• w ro slo
<br />1 NE
<br />URE OF PRINCRAI EXECII
<br />CIONAT
<br />T
<br />E
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />TYPED OR PRINTED WwmvHwn Yryv/aNHMnrNMeMwnimmas rNePM•.1 OFFICER OR AUTHORIZED AGEN Cpp
<br />COMMENTS AND~EXPIANATION OF ANY VIOLATIONS /Rifninc. d/atachm.nts herre/
<br />TSS 6 TU?AL IHUN LIEIITS YtILL BE WAIVED, AND SETTLEABLE SOLLD:i Lid1T APYLiBD FOu C=l0YH~24BF PNECIP LYfhI'j
<br />TSS, I80N AND SETTLEAbL£ SCLiDS LItlITS HAIY£D FUH >lUYH~24ntt eaECle SYFiNE-ATTACtl DOCUtlEYTATiON-S££ I. A. 3.
<br />EPA Form 3320.1108.96) Pn7rioua sditiona may be used. IRE LACES AF ~M T U6E .1 OOOS7/96O2O Z-0943 GE ~F j
<br />
|