|
.E NAME/ADDRESS (brL4 F«u1ryN.Wlnr,rrm 1JOlelr..eq
<br />t:fPrcUS Lr;PII?t G,;~I<u<iiiiL.N
<br />P G .dux a.~
<br />'RA1G LO .~ bib
<br />.'IYPRUS'. EMPIitE C'p~1+ AT C, .
<br />,_R;,tu c.1625
<br />ttiL.naeL W. LL~!'llr G~ast_nr wG'o
<br />~-SL 30 O1.- Jli+
<br />~Ubk Nor
<br />F - FINAL
<br />FrLhUr.
<br />Forrn Approved.
<br />~ ~ n~ i~0~e' ~x~p~ e ~s si-sa
<br />1v47
<br />v4+F Nil Ui~GnAKGE .<rYu
<br />NOTE: Raed Inetruetiom before c tiny thb form.
<br />PARAMETER ~'' l3+Grd Onry U TITY OR LOADIN -`•- rd Onlrl QUANTITY OR CONCENTRATION ~D, FflEDUENCY SAMPLE
<br />13I-371 146-531 1546/) /38-451 !4653 /5a-611
<br />EX OF
<br />s
<br />TYPE
<br />
<br />YAa(EyllGE
<br />`~~
<br />MAXIMUM ~ ITS MINIMUM AVERAGE MAXIMUM UNITS /a-ssi ANUra
<br />164661
<br />l6&701
<br />tN SAMPLE -~FIM<~# 4f~i. {.., <i. ., ~<rr
<br />1 L
<br /> FAEASIJREMENT ~;,~~~ ~,.;
<br />. ~.;U i U': 0.
<br />y P.~: F-:"'>.
<br />~ >~ #1N.;!~fi~?. :-.;;1lI*~~*# ~<,.
<br />~ ~ :.~.,;:`_...
<br />....::,' $St•~<#$ 9.4. 1;iGEl: kAd
<br /> :REOU.It}
<br />s. :%y
<br />...:... .
<br />
<br />111 '
<br />~;. ,_ t ~ 5i. iTLE,.SLt ~'~`$$ *~$44# >!** 25
<br /> ~ A@UREM ~' +
<br />
<br />
<br />J i ... `
<br />.1 U Q a.
<br />r. ~ ? ;?, ....,~
<br />
<br />.:4''p
<br />::':;i~<k~-'..
<br />,..:,.
<br />
<br />~.:
<br />.'K~~~
<br />~
<br />
<br />4
<br />
<br />•
<br />
<br />
<br />
<br />!'#'
<br />#'TliiT.
<br />
<br />
<br />
<br />v
<br />':
<br />ty:,5
<br />i~~/
<br />;RA:S .
<br />
<br />
<br />
<br />... .. ..~...,.
<br />
<br />
<br />...,, :..
<br />,.'
<br />
<br />.,:..,,:..:
<br />
<br />.
<br />:.~.:
<br />-, ( Ar,U ur2EA5t 5. ~;: •#$•*# to***;, $u*i*tt„ ;:. *#***t< 19
<br />+ .~11 Cx ih~(~jRRY MET MEAS
<br />' _ ~~
<br />~~
<br />v7';o i G 0 ~~. ~~~~~`"PER' .',::;'
<br />',^'<> . <M .. :.
<br />
<br />i
<br />?il; ~ 1~
<br />' ,;~:..
<br />n+ItNF11k~P
<br />~..
<br />:
<br />#+~
<br />**Vi~l3i~.'.:>,::
<br />:~ ~,:~III~IFx><4#:: ~.~ .
<br />1<tT
<br />. '
<br />:~~~ t:~~.
<br />'i2~~F3~
<br />'
<br />.v ...
<br />FrL-,...vl „hVS.S V ..
<br />UJRE.AME.., .:n..'~T.
<br />k..
<br />..:~.
<br />....
<br />
<br />.
<br />.
<br />.
<br />A :;':
<br />.: ,,
<br />I:::
<br />
<br />
<br />`
<br />
<br />
<br />
<br />.:
<br />M .
<br />~ .. .
<br />-l.Uws 1N L. :JNJUIT Ilk' SAMPL ";: ~
<br />~~ „j #k#Vr$Y $##$*v ##>«•4$
<br />Ii-."C :. ..2 E:A iMENT PL k~NT F/1EA5)~FjEMENT rnJe:Lt 1~,o..
<br />,~.~.~ 1 „0 U
<br />
<br />.: ,.PERMIT
<br />
<br />...:: riEl~
<br />+
<br />V .. +~4'"+A~Aw +v#*#$# ''iji~lrlnltb# ti<i<<r Ni.L! iYaTAN
<br />
<br />I lil Nr ss v e.uE $UIREMENT
<br />: .:.::::.:.:. ' .
<br />...~:.
<br />~' m-'`: ~ .. -• ~ ~ '' ~. ~ ::' ><$kH ~... ~~ .H
<br />
<br />~ SAMPL ~
<br />~
<br />~ "~
<br />~?
<br />.
<br />.. ~.. MEA511AEfu~ftf ~ ,
<br />~
<br />.
<br />.
<br />
<br />
<br />~' .. ~.. y'. .....
<br />
<br />
<br />~ti'~IRE
<br />T
<br />F1
<br />E y:. ,.e~
<br />.k , ., '
<br />,. ~..'.:.~.
<br />
<br />...: ...
<br />.
<br />.;
<br />
<br />v:. v.:.
<br />~ .M
<br />E
<br />N
<br />. .r'::.. :: •.. ,.; :.:"" ,..'T::,I
<br />~. .. ,. ...::., .
<br />,
<br />
<br />:.:..... .:..
<br /> - ~SAINPLE ~
<br />. h~ASWAEMENT r,,~,
<br /> ...
<br />
<br />. ._
<br />..
<br />;x.
<br />,..:
<br />-~:;
<br />,
<br />
<br />~~~`~
<br />~
<br />~ .
<br /> SA
<br />PL ~~~~
<br /> MEASUR~tT# -
<br />... .
<br />
<br />~~
<br />..
<br />:. ~ .h.
<br />.
<br />,; _°..
<br />
<br />
<br />~
<br /> ..... .,. .. . ,. .,.: ..dii .,....~..<.,::.:.. ..,. .:.
<br />..
<br />NAMElTITLE PRINCIPAL'EXECUTIVE OFFICER (CERTIFY UNDEfl~ENKTr QF,LL
<br />M F
<br />I
<br />I
<br />R
<br />TNF <~~11Yy THAT lHAVEYERSONALLr E%AMI
<br />ON SIIB
<br />A
<br />TTED HFAEIN
<br />AND B
<br />T NED AND
<br />ASED ON TELEPHONE DATE
<br />
<br />' A
<br />AMIL
<br />A
<br />W
<br />H
<br />I O
<br />MY INQUIRY OF TMOB
<br />OBTNNINO THE INFORMATI N I
<br />,I
<br />I
<br />;
<br />yIAA
<br />D lALS~ IMMEDIATELY RESPONSIB
<br />t BEIJEVE THE SUBMITTED INFORM
<br />LE' FOR
<br />ATION 15 /
<br />RicYlard Mills TRUE, Ac ORATE AND CO
<br />SIGNIFICANT PENKTIES FOR ;
<br />MET{, 1' AM AWME THAT THE
<br />SUBMITTNO FALSE INFORMATION
<br />IN RE ARE
<br />CLUDING ~.
<br />~
<br />EnNi ronmental A.iaaagelF THE POSSIBILITY OF RNE AND I ,
<br />MPflISONMFNT. SEE 18 U.S.C. ! 1001 AND G0 eIONATIeIE OF MIINCIPAL EXECUTIVE /
<br />i 97 ~ B70_Z712 7 t7 9
<br />
<br />TYPED OA PRINTED, ~ v.s.c. F tste. rnwa:, u.e« e..,. mrvn, ra,r r.~.e. A'n., w ro r1o.000
<br />,een,au:aMa:ewrswl.er oraw.,n sm«rR1,.nsaFw./
<br />OFFICER OR AUTHORRED AOEM AREA
<br />CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION UE ANY VIOLATIONS !Reference ell efrschments here!
<br />~cITLEAdLE SUC10S t1NIT wA1VEU FuR lUYIts~41n PrLEC1P EVENT-i;EE I.A.3t PG iVF FL.'. I~EduIt~LMEhTS. UIL a
<br />i,lecASt t,RAti SAYFLE AkALY515 ItfJUlktD IF VISIBLE SHcEN IS UiiSERVEU. UF?iRLY SAM1'L.INU 1n 5T RUG TI UNS-l.C.:;.
<br />Y-
<br />EP Form 3320-1 108-95) Previous editions mey be used. (REPLACES EPA FORM T-00 WHICH MAY NOT BE USED.! ilU 3 i 3/ y G 1001 ~ 1311 PAGE 1 OF
<br />
|