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E NAME/ADDRESS e•di4 FafenN.WL«•nm r/D~Dw.•q <br />I ~~ ~~C3iJ9NU VALLEY COAT. _~"FAhY <br />ADDRE551!UNIiGR CANTON NI:/ri <br />Y.O. BOl 7D ...;.,, <br />LOM1 CO B1S24-OOiO <br />FACILITY GRAND "r~LLBY COIL COtlP~NT <br />LOCATION -. <br />FR <br />AT7N: JO.+.A ''1. W.R LT F.RS_ ^^^O~tlsr <br />Forrn Approved. <br />OM~ N~o~~~Q 40A004 <br />SED POND DSCRf. TOAddiba6Fi•Z`~re~~F3~~13 <br />(SUHR YC) 12345 <br />F - FINAL <br />FsINORpp nJ~TT qq~~ (gip ~~(y7 <br /># NOTE„Aeea IiretrCueil-anHi biloNFlOln6letlnp t~lie form. <br />PARAMETER r)OrttyJ QUANTRY OR LOADIIVQ nlY) QUANTITY OR C CENTAATION ND- FREQUENCY SAMPLE <br />l32-37/ W 531 15s-61I -15 !4653/ /5L61 EX DF TVPE <br /> <br />RAGE MAXIMUM <br />NIMUM AVERAGE MAXIMUM UNITS <br />rs~-e.T~ Mursls <br />l6~-eel <br />lealOl <br />IL AND GREASE' SAMPLE ~ #416tC <br />( #{~~ {!#:-^.Y# fi#~##¢ <br />V ISD A L MEASUREMENT " <br /> <br />44086 1 0 0 PERMIT ~ ... ......... <br />:.:;. <br />s#5# ..:... ..:.... .. ... <br />. .. <br />R6R:t1 <br />8T ~ <br /> <br />ES=1 ~....:,~.:: <br />. ~ <br /> <br />~ ###p#Ta ~ <br />~ ..... ... .... <br /> <br />.'.OOA;C~I:#.~~ <br />~: ~ <br /> <br />4+f# . <br /> <br />~ <br /> <br />BEkLT <br /> <br />ISUA <br /> REQUIREMENT <br />,., . . :, <br />: <br />_ <br />.:. . <br />.. , <br /> SAMPLE <br />-, <br /> UREMENT i 'K`im' ' <br /> <br /> <br /> SAMPLE <br />MEASUREMENT <br />~~ <br /> , <br />r <br /> PERMIT .;: s'^-'.:::~~: <br />..:::.z: ~..:. ~ <br />:y: <br />,..r.. . <br /> <br />,... <br /> REQUIREMENT ~~~"~ <br /> SAMPLE <br /> MEASUREMENT <br />~ <br />" <br /> .. PERMIT ...., <br />~ .::....... . <br /> ::FiEQ.V..IREMENT ~ <br />~: r:~~{''•r~:;:~:~'.~. ". <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~~ <br /> <br /> REQUIREMENT ;.: ;:~y-: :::"~~~'-` ~:. <br /> SAMPLE <br /> MEASUREMENT I' <br /> n <br /> ~~ ~ <br />PERMIT .:.:..:::.: ...:::.~:......:...... <br />..: .. <br /> . <br />'REQUIREMENT ~ /'4. ...:~~. " ~:: ~.~~: ~.: .: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> :.REQVIREMENT <br />NAME/TITLE PRINCIPAL EXECIlTNE OFFICER 1 cERn <br />AM FA Fr UNDER PENUrr of uw TNAT I NAVE PERSONULV E%AMw <br />MILIM WITH THE INF00.MATION SUBMITTED HEREIN <br />MD BA ED Mo <br />SED ON TELEPHONE DATE <br />G ('~ ~r,~ <br />E <br />J <br />A MY IN ; <br />OURY OF TNOBE INDIVIDUALS IMMEDIATELY RESPONSIB LE FON <br />. <br />. $ l/i <br />- OBTNN ING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMA TION IS <br /> TRUE. <br />SIGNIFI ACCUMTE MD COMPLETE. I AM AWME THAT THE <br />CMT PENALTIES FOR SUBMITTING FALSE IHFOMIATIOH <br />IN RE ME <br />CLUDING <br />AG y ~~ <br />Fi THE PO , <br />SSIBILITY OF FINE MO IMPRISONMENT. SEE le U.S.C. f 1001 MD 3G ~IONATUIIE OF PflINCNAL E%EC1lTNE <br /> <br />TYPED OiI PRINTED U.S.C. 7 1 J1 e. lhrWC•• 1w~OFr JMa• •drN•s m+Y McluW !•n• w ro E 10.000 <br />I/WbIIMVL9Y11 ~'NbJRVY1Nnr 0/bMNn Q nNn(A)Md6 rY-LJ <br />OFFICER OR AUTHOflRED AGENT <br />CODE <br />NUMBEq <br />YEAR <br />M <br />DAV <br />COMMENTS AND E%PLANATION OF ANY VIOLAI IDNS (H.ISrence se s/fecsmsnrs sere/ <br />Ts'S E 'POT AL IRO+f LI'IT5 PILL 92 ;IAIYED, AVD SETT LEAHLE SOLIDS L*.T 1PPLIED FOR ~=l0YR,24Y.R PYECIP P.YFHT; <br />:iE'PTLEABLE SOLIDS LItIIT KAI 9E YAIV°D PDR >1DTR,24RR EVENT-SE£ I. A. 1, PP 3-4, AND L.A.3, P. 7. QRTRLI <br />O - 401 Qltio !Fm be ue A W O ttE <br />00268/961217-1206 2 <br />