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PERMITTEE NAME/ADDRESS N~dr4 FrNry Nar/Lor,Nm /JDIQEr,u) <br />NAME i:Y~kUS E: r'Ir'lkt LtjK T`U f+AlllJi~ <br />ADDRESS ~ L U iJ it O b <br />. Yt;kA1G <br />to alb~u <br />FACILITY CYPnUS EHPIkE Cl)kF'UKATIGh <br />LOCATIONtkAli, tl~ aldl5 FRE <br />Atl+v Hi~naEL ;.. L'uULl;k, ~cNERAL HGK <br />FoNr~m NApproved. <br />h1 >,I~~ b hh-91N Iu 4~"f~L.o~2,aE}~0004 ,r <br />pprove ei<ptree 06=X31-98 <br />Siluk Hri c~'.~ <br />F - FihAL <br />HIN[1R <br />NOTE: Reed Instruetlaro Mfon eomplet hq thb form. <br />PARAMETER !3 6rd On/Yl QUANTITY OR LOADING ~ p Ey QUANTITY OR CONCENTRATION NO. FRE°UDIm' SAMPLE <br />81-37/ !4653 15i5f >" 14653 61-81 EX OF TYPE <br /> <br />- <br />AVERAGE MAXIMUM UNIT$ <br />UM AVERAGE MAXIMUM UNITS <br />leaen Mi4Y519 <br />l51-5e1 <br />l5s7D/ <br />uIl- AhU i;KLASE SAMPLE Yr##### 74 #t,### 44pir#{ ##i„F#4 <br />V 1 JI.AL MEASUREMENT <br />o4~bo. 1 U U ~~~.~ PERMIT ~. #;f ,y#st# ... ... .: .... ... <br />[FhLU~hi ~ka5 YALU REQUIREMENT N (.:.,..-_::; -!::.,.;. :.;. ; .. .::. #### <br />i.. .~ .: <br /> SAMPLE <br /> MEASUREMENT ~: <br /> <br />.. ....... <br />~ ~. <br />... ~ <br />:: <br />:ca~~a <br /> <br />'.. <br />~~~:.~:..'. <br />: <br /> <br />. <br />;. <br /> :FiE <br />4U.lAEMEN7 ~ . ~ . <br />:. <br />~~~~~ ~:~::::•.'.:;~- . <br />. <br />;~:. .. .. ...::..... <br /> .. <br /> SAMPLE <br /> MEASUREMENT <br /> .: .... ~. <br />~ <br />' <br />~ <br />~ <br />~ ~~''# ~ <br /> :R,EQUIREMEN7: ~ ~ ;.,,~y: <br />:.:~ <br />;:: ~.:- <br />; ~ <br /> SAMPLE <br /> MEASUREMENT <br /> :~'~.PERMIT~ ... . <br /> .REQUIREMENT ~ ~ ~ ' ~ ~` <br /> SAMPLE <br /> MEASUREMENT <br /> .~:~;: ~:f EHMl7..:~~. ~ .., ... .: .. .. <br />~ <br />~ <br /> ~REQUIijEMEf1T. . .. .~ ~. ~: ~ <br />.: ~ :::.: . <br />: <br /> SAMPLE <br /> MEASUREMENT <br /> ~: ~: ~ PERMIT :.~ ~ ~~~ .... .. <br /> FfEQUIREMENY <br /> SAMPLE' <br /> MEASUREMENT <br /> :r~fERMIT.;.~~~~ ..... ... .: .: ~ .. <br />~ ~ .~ <br /> REOUIREMEfaT; <br />:... ..... ~. :.. <br />... :.. ... .... ~ . <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI <br />AM FA FY UNDER PENALTY OF L <br />MILIM WITH THE INFO AW THAT I.HAVE PERSONKLY E1(AMIN <br />RMATION SUBMITTED HEREIN; MO OA ED MD <br />SED ON TELEPHONE DATE <br /> <br />Richard ifl~~5 <br />MY INOUIM OF THOSE INDIVIDUAl9 IMMEDIATELY RESPONSIB <br />LE FOR , <br /> OeTAIMINO THE INFORMATION, 1 BELIEVE THE SUBMITTED INFORMA TION 18 <br /> <br />Environmental A1ana~er TRUE. ACCUMTE MD COM-LETE. I AM AWME THAT THE <br />910NIFICMT PENALTIEe FOR SUBMITTING FALSE INFORMATION <br />IN RE ME <br />CLUDING <br />r / <br />~]Q~ g70-Z7~ 2 <br />7 <br />~] <br /> , <br />THE POSSIBILITY OF RNE MD IMPRISONMENT. SEE to U.S.C. 1 7 W 1 MD 7J j <br />eIONATURE OF PIIINCIPAL EXECUTIVE l <br /> U.S.C. f t 7t e. lhn,lU„ mNr d.,. mrvro, m, y AxMd, M„ w ro i 10,000 <br />TYPED OR PRINTED wnmuNx,n `norl~vl.,raaw,.ee~n,.nFS r.,rA+ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANV VIOLATIONS +Refrrencs s+l sttschments hsrel <br />:,ciiLEADLE J:JLIL~ t_1`t(f WAIVE.: FI:K iJl'nFZhrirt PI<tI.LP cVCt+T-;c[ I.A.jF rU lVF FUk rttvaulK[MENTS. (,1L <br />~K~„:,E i,nAb _+AMNL!_ ANALY~I~ KEUIJIKLU 1F V1S1dLE SHEch IS lld~rlt'/E0, r~TriLY SAMPLIf.i, INSTRUtTl~tV$-1.i;.nF <br />,~ <br />EPA Form 3320.1 108-961 Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.1 J UL U ~ / y b 1 ~ v 1- i 311 PAGE lOF <br />