Laserfiche WebLink
~~ <br />PERMITTEE NAME/ADDRESS (lnc/ude Faciliry NamrlLocmion tfDifferent) <br />NAME FLCt:kTwI6}. FfiCCA:SIN(-,, L1C <br />ADDRESSN k Yi E L M !! I H E <br />1111 BliflITUCGL CF.IYF <br />FACILIiYBYAF;YILL} Ia Y7711 <br />LOCATIONr L c T G ,~ r <br />C.. B1G91 Fq( <br />A17':.: AL }kHHY, P:AfiAGE:t <br />r <br />Form Approved. <br />C i eC F OMB No. 2040-0004 ~ , <br />Approval expires 05-31;98 ~ <br />1`-LIEF ~E) ' <br />F - EIFAI IA;;A`_- <br />ACUIF IIEI Tk°_T71C FCF (CIE <br />y~. Yl }C [3_C kAFCE j~~ :o>: <br />NOTE: Read Instructions before Completing this form. <br /> (3 Cerd O <br />) UANTITY OR LOADING <br />5) ~•) ~ QUANTITY OR CONCENTRATION NO. FREOUENC 'SAMPLE <br />PARAMETER 3 <br />s <br />( (54-6/J ~ 8-45) (46-53) (54-61J EX OF TYPE <br />(3237) AVERAGE MAXIMUM UNIT_ IMUM AVERAGE MAXIMUM UNITS <br />ISZ~s3I ANALYSIS <br />(64-BB/ <br />69-70 <br />LCSU STAThE: utlHP P.CL SAMPLE ^a~"'~'` rxao>7~ ;goae sct;~=; ( ;_) <br />C k h I C [: h r .:NI A MEASUREMENT <br />Ii'Ii 1 C C PERMIT il-a00irA s X t>:=~ ~ ;.+ 161110 C <br />F IE- +: ElY 'FAk <br />kFF'LUE4T GkG`.~S YdLLk AEEyU1REMEFtT t4. ~ (~~ ~ +"~ <br />a , CE~i <br />ICSU 5'C AZ fit? 96Mi~ ACL SAMPLE •; O•""' •~_: '"' A8>r+A O o:~SyY I ._) <br />l' 1 P. E; :1 A L t S MEASUREMENT _ <br />IehbC 1 U G PERMIT aurr~=+~ ae>;naa 14'- 3 G P' ~ ~ E }~- G 1}I1 FAE <br />:'E'FLUE±IT Gk059 YALCE "Fa~QU113E1v1ENT r:: ~ f.G YAL(t . <br />}4 +,~`` Ctn1 <br /> SAMPLE <br /> MEASUREMENT <br /> `- PERMIT ~ <br />QUIREMENT <br />- <br />- ""r <br />~ < '' <br />` <br />~~r~ <br />` <br />~ <br /> r ,~ .. R ~' <br />^ <br />°.-: <br />- <br /> SAMPLE <br /> MEASUREMENT <br /> ., ~ERMIT <br />- <br />~ ~ f , <br />` <br /> UIRE~iLNT v ,, ~~. ~ <br /> SAMPLE J <br /> MEASUREMENT <br /> <br /> 1jf6(E~IEiEMeNT . <br /> SAMPLE <br /> MEASUREMENT <br /> ~~RM}T . w ~ . ~ <br /> AEdUIREMGNT <br /> SAMPLE <br /> MEA <br />S <br />U <br />R <br />E <br />ENT <br />M <br /> ~S <br />/y <br />~ <br />n <br />C <br />~ <br />p~Qlrltl <br />~~ . <br /> . H <br />' <br />4 <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER <br />PENALTV OF <br />AM FAMILIAR WITH lHE INFORM lAW THAT I HAVE PERSONALLY E%AMINED AND <br />ATION SUBMITTED HEREIN <br />AND BASED ON MY ~ TELEPHONE DATE <br /> <br />r ` <br />~ <br />~ <br />G INQUIRY OF THOSE INDIVIDUAL <br />THE INFORMATION <br />1 BELIEV ; <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />E THE SUBMITTED INFORMATION I$ TRUE /~ , <br />y <br />/ <br />1 <br />- <br />• <br />r , <br />ACCURATE AND COMPLETE , <br />I AM AWARE THAT THERE ARE SIGNIFICANT ' , <br /> , <br />PENALTIES FOR SUBMl1TN E INFORMAT <br />INCLUD <br />NG THE <br />F <br />L <br />ON <br />G { <br /> <br />M 4 h ~ r <br />POSSIBILITY OF FINE AND IMPR A <br />S <br />I <br />. <br />I <br />. <br />ISONMEM. SEE 18 U.S.C. § 1001 AND 33 U.S.C <br />IGNATURE F PRINCIPAL EXECUT E (/~~ <br />D 1 ~ (~ <br />O 4~'~2~ <br />DO <br />~0 1 <br /> <br />TYPEIS OR PRINTED g 1319. (Peretties user Ilrese stefu(es may include hoes up ro S10,fUd entl or <br />mesimum impnsonmemolbenveen Bmarrns entl5 <br />eersJ 'OFFICER OR AUTHORIZED AGEN A <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> y C <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference al! attachments here) <br />:tt i.A.l, PF 5-7, EC} L't'IA1I_ CF TEST PkGCFCC~.E. FcFCF'I ICSC - 51AT75TICAL FCIA1 t5T1ClTE YEICE I`_ <br />Li.i:I;.L TU ~U+ CF TE_1 UHGFNI585, AND ATTACH ACUTE 7^XIC77Y IFST F4FGF.1 FCiM TC CPf.. CCFIE~ CE OI[ <br />T=~n~ n e c c <br />Form <br />editions may notbe u~~d.: 4 ...(REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) C C C G ~/ C C C 1 ~ 1 ~ 1 E ,t C .. PAGE 1 OF <br />