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PERMITTEE NAME/ADDRESS /IntlVb FxrLry Na/Iuellm UDlafnart) <br />NAME I. YPKUS !: hi ('INL L_;nl'L,~AT Iu'~ <br />ADDRES `~ IJ c(1X f)d <br />~.; ~kAlL; GU tilu[.~ <br />FACUm (.Yr'KUS tMPIkE CGRPURAiI•C1N <br />LocATIDN~nAIU `CU tl1b25 FRE <br />..l (N n1CrlArl N. LUULL'ar. GENEKkL FIdR <br />Form Approved. <br />n. ~ ~ v .~ N ~ "y 1 a T LJ 0 B Iry~o77;O1g0-0004 , } <br />~ipb~bbere>,Cpir'~e~ OS--'d~1.98 <br />~UL,K ,v r, 1~j4~ <br />F - F1irdL <br />:~ I N0K <br />+~~+ hG ulil:NArtGE r~# <br />NOTE: Reed Inetruetlons M1er eom letlnp this form. <br />PARAMETER 13 Cerd Onty"). QUANTITY OR LOADING d Only) QUANTITY OR CONCENTRATION ND~ FREQUENCY SAMPLE <br />137-371 ~ 11653 51-5! /38-15 4669 6F5/ EX V5 <br />s TYPE <br /> AVERAGE MAXIMUM UNI MINIMUM AVERAGE MAXIMUM UNITS /13.em 1 <br />MAL <br />181-881 153701 <br />r'F SAMPLE ###tF## #####4 - tia4###ta 1L <br /> MEASUREMENT <br />~ <br />.. <br />u (.y~U 1 0 0 .. ~ ~ <br /> <br />LFFLULNI UR S'S VALUE REQUIREMENT <br />~ .: ~>. .. <..:. ;:: ~ .. <br />~:,:.;;~:;:";:.,:.: <.:.. <br />..:~~:..~...:. # #+ ,f <br />~ ~..:.: _ <br />~:.:: ~..::~ :~: r <br />~..N'~, <br />..~~r ... <br /> <br />,. <br />~L.L1ii5F ~tTTLtAuL~ SAMPLE {...,y#!y, u##~t:r~. 4##!!! Z5 <br /> MEASUREMENT <br />vv>4S 1 U C ~:: ~PERMIT:~~~ 'u4#i~k~-:; :': ~~: $r#1'#:#yF rf {. ;. vr+ir a#!!#'`. :~~~~~K~ :~ <br />~~~ ~Q~~~~ ~ E1C~~I~~~ '~AIr+:~.'. <br />~a~ <br />tFFUur_nT UkU55 YALUc RE.QUtNEMENT Y,#„Y ;:~;; : . <br />U1L ANU ~KtA$E SAMPLE is#~##* 5\ry#~Y#tia yrj ti.:a,;.>t !#i•!#O 19 <br />FltcuN to lz-GFtAV MET MEASUREMENT <br />(iLJ'JG 1 U G ~~PERMIT ~ ##$#'#~:~:3~'. ','~.,;x'iK#f ~'~`! k#{~ #pv##4 ~~ #~!'k'k'##L:~ <br /> <br />-... <br />•.:: <br />:~.Ir <br />~: <br />~ <br />~~ .~. ~Q~$(Y Iv~.~'( ~~i;~r~ : <br /> <br />,: FrLUi:;vi GROSS vALU- REQUIREMENT -~"'' "~" ~ <br />l,:r~:.:.: <br />#,~a <br />, <br />~ , <br />. . <br />, <br />~ ~ <br />~ <br />~ <br />E-Ll, rlr Irv lL1NOllIi G(2 SAMPLE 'v1 f•i iay.}# #####G #!~### <br />TFKU TK-_~IMt FIT PLxNT MEASVREMENT <br />i (,~~u 1 l: U ~ PE~iM1T~ TiEF'llli 7:~ `.' .s°~E:P1I~R.T <br />k: ~. IF#~}#M4 ~ Gfir %~~##~ .~lv id ~},iR iF4 ,;.,r; .} ~ '~!I l.~~ ~ (l+.(~YQI: <br />~FrLUcrv ( GKLiSS YALUE REQUIREMENT 3ULA. AY ;:i . <br />a 1l= C b1X G:, +'### iV ~. <br /> SAMPLE <br /> MEASUREMENT <br />~ <br /> ~: :..: PERMIT,:. ~. .. ~ ::..:. ..:~.~~;~. <br />.. <br />,.. .. <br /> <br />,. <br />~ <br />~ <br /> <br /> <br />~ <br /> REQUIREMENT ~ ::..~: ;y~i':: ~ ~ ~ ~ <br />; <br />....~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .~ <br /> <br />- <br />,... <br />.. <br />: <br /> <br />. <br /> REQUIREMENT ~ . : <br />: <br />~ ~ ~ ~ ~ ~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> <br />;:. PEAMI.T'...: :... <br />.;. . <br />:. <br />~ ~ <br /> REQU <br />IREMENT:: ~~ ~ ~`~~~~' ~: <br />~ <br /> . <br />NAMElTITLE PRINCIPAL EXECUTNE OFFICER 1 CERTI FY UNDER PENKTV OF L <br />E INF <br />M W <br />T AW?NAT I HAVE PERSONALLY EXAMI <br />TTED HEREIN <br />MD BA <br />R <br />T <br />ON SUBM NED MD <br />SED ON TELEPHONE DATE <br /> ; <br />AM fAMILI <br />I <br />H TH <br />O <br />MA <br />I <br />I <br />MY INQUIRY OF TNOSE YNOIVIDUALS IMMEDIATELY RESPONSIB LE FOR <br /> <br />i~l :}l8 rd MI(l5 OBTNNINO THE INFORMATION, I BELIEVE THE SUBMITTED INFORMA <br />TRUE, ACCURATE MD COMPLETE. I AM AWME TNAT TNE <br />IN <br />TTING F <br />SE INFORMATION <br />T <br />F <br />R TON 19 <br />R( ME <br />CLUOINO <br /> <br />/ <br />\ <br />' <br /> <br />:=nv(ronmenta( IG~Lllld,j(dr , <br />910NIFCM <br />PENALTIES <br />O <br />SUBMI <br />AL <br />TNEPOSSIBIUTYOFFINEMDIMPf1130NMENT. SEEIOU.S.C.11001MD]7 <br />AI <br />NATUREO <br />fRiINCMA <br />EXECIlTN (J70 <br />L 870_Z~T <br />j <br />11 ~ ?7 9~ <br /> u.B.D. 1 1911, IPrWaY• urrrr rnFr mnmr rrlrr YchrFi Bnr1 y ro rrooaD O <br />. <br />L <br />E A A NUMBER YEAR MO DAY <br />TYPED OR PRINTED e+s snrrtMUn MrwrlevneTr erernr... rnrmohsW a F.val OFFlCER OR AUTHORIZED AOEflT CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lRl/arencs s!I ethehmen4 hero! <br />~tiTLtAbLC SULIL;~ L1MIi rlAlYtU FMK lOYI%r14HK PdEI;[P EY~11T-icL. [.A.sr N~ IVr FLri :«.tUIREMEhTS. :;ii. ~ <br />~ntASt ~r<Ab SA;,NLE AC.wLY SIB r:E~Ul k"tU IF V1~itiLc SHELN IS Lit S~KYc U. dhTKLY ~AMPLII+~1rvSTFlUC1IGW;-1.L. o, <br />I~ <br />EPA Form 3320.7 108-96( Previous ediGom meY bs used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) 0 U 1 U 1 /'i o 1 G 0.(-1311 PAGE lOF <br />