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r <br />PERLu7TEE NAME/ADDRESS pMr4FrmryNaw/Inculan UDI~nW) <br />NAME TERnUP CR~F:Y, CD"PANY <br />RDDRESSTERr2JFi ~F'F;EA LUADJUT <br />1840 NI~f!MAY 133 <br />PAU;/tA ~~ B1aZ9 , <br />FACILITY <br />LOCATION <br />-`iti-TMi KELLY PRItZLF:R, <br />~,. <br />~Pr.RArt~NS n;s <br />Form Approved. <br />5 F: D I F 7 N D k ]. 'f 0 YOI~BUI~o12040 f00p~ N <br />(SUER JCS Approve! L~~r~e;0~~-31-98 <br />F - FINAL L <br />KINOR <br />NOTE: RBSd InewctionF bB1on complBtinB thbt Corm. <br />PARAMETER l3 Glra Onlyl OUANTITY OR N G ! Onryl QUANTITY OR CONCENTRATION ND. RIEOUENCY SAMPLE <br />l3Z-371 IIB53/ 75x6 ~ 738-~51 !46-53 - 15I-5II EX DF TYPE <br />' AVERAGE MAXIMU ITS MINIMUM AVERFLGE MAXIMUM UNITS <br />!sS-6]I Murss <br />161-687 <br />163701 <br />IL AND GIt2ASE SAMPLE ,`••`x'T7: 4:G?tL4 ;rG4 #R G-'.~~}.^-~a <br />r I S U A L MEASUREMENT <br />4046 1 0 J PERMIT . o~l;kpsp R[rP~+3f 2 E5=1 3<ibOaC#:: ::. 4a'uG ~. >x#~xitS'C < 4:`:` F ;' <br />.FrLY T f. <br />'~•+JAL <br />EF.PLU6NT ;H755 VAL!IE '~EGUIREMENT <br /> SAMPLE <br /> MEASUREMENT ~ ' <br /> sue,) ' <br /> ~~ PERMIT <br />,.:. <br /> REQUIREMENT ~ ~ ~ ~ ~~ ~ ~ ~~ ~~~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ - <br />~ <br />~ ~ <br /> gEQUIREMENT . ~.. :".. . <br /> SAMPLE • <br /> MEASUREMENT <br /> PERMIT ~ ~~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> .. PERMIT .. ..: ~ :.; , ~:: ... ... .. <br /> :REQU.IRENIENT <br />,.: . <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> ~:~REQUIREAiIENL: ~~ <br />~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cERn <br />AM FA Fr UNDER PENN.TY DF <br />MILIM WITN TXE INFO uW THAT I NAVE PERSO <br />RMATION SUBMITTED N NN.Lr E]AMIN <br />EREIN <br />MD BA ED MD <br />SED ON TELEPHONE DATE <br /> MY INDUIRY OF TNOBE INDIVIDUALS IMMEDIATEL ; <br />Y RESPONSIBLE FOP <br /> OBTNNING THE INFORMATION, I BELIEVE THE SUBMI TTED INFORMATION IS / <br />~~/ / <br /> <br />TgUE, ACCUMTE MD COMPLETE. I AM AWM <br />BIGNIFICMT PENN <br />TIE9 FOR SUBMITTING FALSE INFO <br />E TNAT THERE ME <br />RMATION <br />INCLWIMG X <br />/ <br />/ <br />, <br /> . <br />T <br />E POSSIBILIT <br />F <br />E M , 7 Z - S O4 <br />K Y FR I T R H <br />Y OF <br />IN <br />D IMPNSONMENT. SEE 1B U.S.C. F 1001 MD 3] SIGNATURE OF NpPAL EXECUTNE D <br /> U.S.C. 1 t3tY. IPUrRN, uK,r IMw ,dNw, mFF hc,.l, l,w, tp ro J 10,000 <br />TYPED OR PRINTED uMarmwYmn Mpiwwrwrt,Ibrwwn6montn,,M6y,ra1 OFFICER OR AUTNOgIZED AGENT CODE NUMBER YEAR MO DAY <br />G V MMCN 10 AIV V tAPLANA 11 VN V N ANT V I V LA I I V NS lMBEBFBIICB e// lfleCDrnBOfS /IBIS/ <br />SHTI`LKAULi SOLIDS LI"!Ii APPLIES ,/NLf IF C= to-YF!, 24-HP PRZ.:iP cVcalT 15 CLwIF:A. IF CLAIM APPROVED BY <br />FI~CD`F TSS G IRO"! LIyItS MILL NUT Lib APPLIi;U fD 2EPC'r,TFL' YF.AoJnLiIEAi~--S ° I.B.lA, PG 5 AND I. 9, 1G, PG fi. <br />ST~.ti,BEYBTFY MA NO ^_FN4`NT Or IN h11C 1-t_]0 <br />332v-7 106-951 Previous eatdons mey De used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE <br />olofii~zDe19-IZS4 , <br /> <br />