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PERMITTEE NAME/ADDRESS prrb FrleryN~./lor,/rm UDIQG.vrq <br />NAME TEAetJR ~~;-''q 'DVvAvY <br />ADDRE66TEAA~A ~P.i?ER L~R;/JJT <br />1940 NIG9fIAY 133 <br />PLJ!VIA f,',D:;87,U29 <br />FACarrr - <br />LOCATION ~ ' <br />ATTN: KLLLY fAIPbLER, :1PERATIO$S qaA <br />Farm Approved. <br />;, ii :~ (, G 1 Y J ;: D• ~ N Q~B:~o. Z04Q-~ N <br />(SUBk WC) APProvel e7c~~~~ - 1-98 <br />P - FINAL 1[ <br />HINOP. <br />#aa NO DISCHARGE' I~XJ~X~ #~ <br />NOTE: Rud inetructlone before completing tfib form. <br />PARAMETER l3 Grd On/Y/ QUg N ITY 6R:LOADING .+r, Grd Onlp~ QUANTITYO CONCENTRATION NO. FREQUENCY SAMPLE <br /> 116-5A1 - l5L'6/I 138-15I !46$31 154-611 EX DF <br />131-37/ <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINI UM; <br />~. <br />AVERAGE <br />MAXIMUM <br />UNITS <br /> <br />lsasm <br />ANALYSIS <br />1µ6g1 TYPE <br /> <br />/65701 <br />H ASE SAMPLE :~~SR.;: ( 9x) R3~R4+ ,^-C+a 41k G~"-r"'r: <br />I S U A L MEASUREMENT <br /> - <br />4U66 1 0 D PERMIT arxax~;x . R£Pt?4~: ill "Lisp ;; ;:- :#>O~~kYk ~ ;-YV-'~~~ = ~-.= f.BKLY SU11L <br />I <br />PFLOdAT GRASS YAL'JE REQUIREMENT . - . <br /> <br /> SAMPLE k <br /> MEASUREMENT <, <br /> ~... PERMIT ~ . <br />, ; . <br /> :REQUIREMENT ^.,,, n <br />~. ~~.. . ~ .. ~~~. <br />:: ; <br />........ ... 1 <br />,, <br />~ ~.,. <br />~:< .. . <br /> SAMPLE <br /> MEASUREMENT - <br /> :d', . <br />' ~ PERMIT <br />~,. . <br />~;.. ~~'~~~ <br />'~ <br />~~ <br /> ~REQUIREMENi ~'~~." <br />~ <br />. ~::." ,. .. <br /> SAMPLE <br /> MEASUREMENT <br />r <br />' ~ PERMIT :« <br /> REQUIREMENT .~ ~ ~ ~ ~ "'~ <br /> SAMPLE <br /> MEASUREMENT <br />~ <br />~ <br />~ <br /> ., ..PERMIT ~ ~:: :.: , .. <br />.: <br />~ ~ ~ <br />~~~ <br />~~ <br />~! ~ <br />~.".. <br /> :REQUIREMENT ~ ~ <br />- ~ <br />' <br />.. .,. L. <br /> SAMPLE <br /> MEASUREMENT <br /> ... :PERMIT ~ ~ :~;~ <br />.:~: ~>:~ ';;~ .:~ . <br /> `REQUIREMENT ~~~ ~ . <br />~ ~"~!~ W <br /> <br /> SAMPLE <br /> MEASUREMENT <br />~ <br /> . <br />PERMIT <br />~ ~ ~ . ~ .. r .~; <br />. .. <br /> . <br />. <br />~~REQUIREMENT~ <br />~ ~ ~. ~ '.'~1 :. ~~ <br />NAME/TITLE PRINCIP.Ip1.~EXEf:UTNE OFFICER I DERn <br />AM FA Fr uNOER PENAtrr of uw TNAT I NAVE PERSe <br />MILIAR WITH THE INFORMATION SUBMITTED H wµLz:EAAMIN <br />ER <br />AND BA <br />IN ED AND <br />ED ON TELEP,}I:= ~ DATE <br /> E <br />! <br />MY INOURY OF THOSE INDIVIDUALS IMMEDIATELY RE$PDNSIB $ <br />LE FOR - <br /> OBTNNING THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMA TION IS <br /> <br />TRUE. ACCIIMTE AND COMPLETE I AM AWME TNAT THE <br />SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />IN <br />RE ARE <br />CLWING / <br />'~ <br />KELLY FR I TZ LER , <br />THE POSSIBILITY OF RNE <br />ONME <br />T <br /> AND IMPRIS <br />N <br />. SEE to U.S.C. E 1001 AND G] <br />SIO ATt81E ~ CIPAl EXECUTIVE 17 ~ G- S <br /> U.S.C. f 1310. gMWtY, MIOr er« ,uNn, nI,F AcArs, Arr, W ro l ]0,000 '' <br />TYPED OR PRINTED .nsrrn.rwe.n MM+wr/rrr o/b/w«nemmN,,M6F.va/ OFFlCER OR AUTHORIZED AGENT CODE NUMBER: <br />' YEAR MO DAY <br />mGn I a nnv urLnnn r wn yr nn / vlvLn I wno Irteleranca e// sneCnmmrs nele/ - <br />:iETTLEAbLE S)LIDS LI!!IT APkLIES D.VL4 Lh' := 10-Y R, 24-RN PRS~IP 89EN'I J:5 CLAI!'13G. IF CL :IC 1Lpp8GYED 3Y <br />S <br />7000, TSS S LRJN LIMITS '1ILL NDP iY AP?LIED PU REppRT.6A '7EASUkLEbE.tiT5--5 E i.8.1A, PG 5 ANCY;E:r.8:1CF PG 6. <br />CTnonua Tan r.u•^oaeu~ r., ... ..un . . ... - .. <br />320.7 108-961 Previous editions mey be used. (REPLACES EPA FORM T40 WHICH MAY NOT BE USED.1 PAGI <br />0162/97D819-1254 <br />