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PERMITTEE NAME/ADDRESS pMr4srN'gN~.e'loc.dm UnIO•...U <br />NAME TL~RifJR :EEb'~i COtlPANY <br />ADDRESS TERROR ..FEES LOADJUP <br />1B4U HI„HOAY 133 <br />PADNZA: ~h~0 81429 <br />',fACILITV • ' ,., Y..~F ..~ . <br />' LOCATION ~' <br />• R k <br />ATTN: BELLY FRSTZLERF OPERA'!' ','HER <br />Form ADProved. <br />SSDI Y~ND R1 TO ND"P~MP7C2~-99P1i59 <br />(SORB WC) APPr°vel °x91Ie}j05-31-98 <br />P - FItlAL 1L <br />°. MINOR <br />~~~ N~ DISCHARGE ~XX~ #8r <br />NOTE: Retd Irotructlarr belaFe eompletinp thit form. <br />PARAMETER !3 Grd Onhi OVANTiTY OR LOADING Card Onhl O TITY OR CONCENTRATION NG FREQUENCY SAMPLE <br /> I~6531 1565E 135-15 !1653 515/1 EX DF <br />l3Z-371 <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUak <br />AVERAGE <br />MAXIMUM <br />UNITS <br />lees/ <br />I61 YSBI TYPE <br />!59701 <br />i3 SAMPLE rr:$kC ~ 94) ~## ~### $: v#~:=r ~# <br />ISUAL MEASUREMENT Y _ -: , <br />~, :; <br />40b 6 1 0 J PERMIT ### ##'Y " _, <br />$$=1 <br />~.'4 .1 . , <br />.::;~::.: Act 9~ <br />##n#~~ <br />,.,. <br />EERLY <br />ISOAL <br />EFfLUSNT 'oR15:i i4LU, REQUIREMENT ''q.';^'1": 'E::`::: <br />. <br /> . <br /> SAMPLE ' '_~~~ <br /> MEASUREMENT ~~~• <br /> ~~. 'PERMIT ~ ~ .~ ~:.:.:.::;:;~. :,, .:..•, :~i a•~i; ~1;.. <br /> . <br />`FIEQUIREMENT. .- .. ~ ~~~ 'g-, .zb~?'~".~'.~~..', :, .~., ~, ~. <br /> ~ ~~ <br /> " F~ <br />~ <br /> MEASUREMENT ` ~. <br />.' <br /> ~.~PERMIT ~ <br />~`.. <br />. .~~`i <br /> REQUIREMENT .. e~. «.,:: ;:;.~. <br /> SAMPLE ~ ; ~~ <br /> MEASUREMENT <br />~ ` •. <br /> PERMIT. ~..~. ~; <br />. ~ <br />~ ~ ~ !~~ ~~~~~~~~~ <br /> <br />:~: <br /> <br />~ .. ~ q ~ <br />~ ~ ~' <br />:.. <br /> <br />;: <br />~~ <br /> 'REQUIREMENT ~ <br />> <br />,.. <br />y <br /> <br />. <br />.: <br /> SAMPLE '. m ~ ': :!i <br /> MEASUREMENT - '~~ `~ <br /> ' . <br />. .. <br />~~ <br />~ <br />~ ... .. .. <br /> •IiEQUIRENIENT :: ,, . <br />~ ~ ~ <br />~: ~ yf ... <br />.: ~.~ <br />~;:~; :r:~~'":~ ~ <br />-. ....:. <br /> SAMPLE ~ '~ '- <br /> MEASUREMENT <br /> "~ ~~ <br />~ <br /> .REQUIREMENT ~ ~ ~ ~"~ ~; ~ <br />~r <br />~ ~ <br />~' ~ <br />~ <br />~ <br />L L' .. <br /> . 4 <br />: . <br />.. <br />x <br /> SAMPLE - <br /> MEASUREMENT <br />• <br /> <br />PERMIT: <br />: .,. <br />.,. ~~.: ..:. <br /> <br />:. <br />~ <br />::. .~ <br /> ... <br />~REQUIREMENT~ ~~ ~ ~ .. :<.,: <br />u; :~: .... <br /> . <br />NAME/i1ttE PRINCIPAL EXECVTNE OFFICER I CERTI FY UNDER PENN.TY OF LAW THAT I NAVE PERSONALLY E%AMI NED MD ' <br />~ TELEPHONE DATE <br /> ABI FA MILIM WITH THE INFO D HE/1EIN; MD B <br />RMATION SUBMITT ASED ON , . <br /> E <br />MY INOURY OF THOSE INDINOUALS IMMEDIATELY RESPONSIB LE fOR - <br /> OBTNNING THE INF(NWATION, I BELIEVE THE SUBMITTED INFORM ATION I$ C, 70 ~ i <br /> <br />KELLY FT I TZLER OPERATIONS MG TRUE ACCURATE MD COMPLETE. I AM AWME THAT THE <br />510HIRCANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />IN RE ME <br />CLUDING <br />` <br /> , 8%8 5855 <br />924 <br /> THE POSSIBILITY OF RNE MD IMFRISONMENT. SEE 18 U.S.C. F 1001 MD 97 • <br />NE <br />F <br />TYPED OR PRINTED wnmuSh ~.n irw~~s~++~ rt~ro/sr~ir~t~nm.ins5~~~•~rotlo,000 S qN E O <br />ALE <br />~ `~FFlCER OR Ui/10RIZED AGENT AR A <br />CODE y,M~R YEAR MO DAV <br />COMMENTS AND E%PLANATION OF ANY VIOLATIONS (Rdwtnn d/ettaehments htrl <br />SETTLEABLE SJLIDS LI!!I[ aPPLIS5 ONLY IP := 10-YBF 24-HR ?RE:.IP cYSNT 2 ~LAIMBD. IF CLAIM APPROYSD BY <br />NQCDt T55 ~ IRJN LStlITS WILL NOT BE -PPLIED 2J RS PORTED 7EASJhEMBNTS= ~.$ I. BelA, PG 5 b)D x.9.1Dt PG b. <br />STAB118~TRR MB WA :F.M pqT Df.JN OeP 1-7_U q_ <br />EPAjwm 332Q-1 108-961 Prsvlout edltione mey bs used. (REPLACES EPA FORM TAO WHICH MAY NOT BE USED.) ~ PAGE OF <br />0/970819 ~ <br />25r 2 <br />4 _ .. , <br />