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PERMITTEE NAME/ADDRESS dM.b ixrGryNaWL,r,nw UDlpb..r)
<br />NAME LYr,q„S rhti'ir.c, LUnPuiiAT itJ(r
<br />ADDRESS P U OLIX GJ
<br />CRAIu CU 111626
<br />FAc1uTY LYPr,LrS LMt'IxL CilKriinAtlLi~
<br />LocATaNLKA, ~ CO 151625
<br />r,Ilti H.Ii.t+AEL n. LuuLUnr UENERAL klik
<br />Form Approved.
<br />t•, .; , c ;^. i Ivt T u i. 1L~~~.No.120r40-oooa
<br />pprove`4 sxpirpe 05-31 ~J8
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<br />NOTE: Reed Inetruetlone before co pletlnq tide form.
<br />PARAMETER 13 Ord Orilyl QUANTITY OR I ~ O la C.rd On/yl QUANTITY OR CONCENTRATION NO, FREQUENCY SAMPLE
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<br />/31-371 14453 l5b5r :~• 3B-e5 <663 l5L6r EX ANALY9B TYPE
<br /> AVERAGE MAXIMUM ~ TS INIMUM AVERAGE MAXIMUM UNITS /e~.e3) !5a•6Bl rQ47o/
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<br /> MEASUREMENT
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<br />f LI %,L r;~CL:YEKAoLE MEASUREMENT
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<br />NAME/TITLE PRINCIPAL €XECUTNE OfFICER I cl[RTI
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<br />':IChi: Y('1 rr111~S MY INOUIIIY OF TROSE INDINDUALS IMMEDIATELY RESPONSIB
<br />OBTNNING THE INFORMATION, 1 BELIEVE iNE SUBMITTED INFORM LE FOfl
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<br /> TRUE, ACCUMTE AND COMPLETE. I AM AWARE THAT THE
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<br />SIGNIFICANT PENAlTlE9 FOR SUB
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<br />~ THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE IB U.S.C. 1 1001 AND 3G
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<br /> U.S.C. I t9[e. IArm,W,..nlr err mem, m,y 41cA.tl, A+r. W ro i 10,000 610NAlURE OF PRINCI
<br />AL EXECUTIVE AR A
<br />NUMBER
<br />YEAR MO
<br />DAY
<br />TYPED OR PRINTED wormulm.n Mpfsmwrt a/Mrwwn6menNarM6y,ral OFFlCER OR AUTHORRED AOENi CODE
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS lrrerorenCe u/ erreenmena nerel
<br />I L::a LlhilT Ar'i-'Lien 7u CuPItlIVtU FLLN FKJtt OJJF G~c L J~4. i1IL- ~ u~iA~~ I,.?Ao ~AP:PLc A,SALYSIi ~t_ri!/lL:-u I~
<br />rt.inLC nHtLlr IS~IasSLk.Ytu. wt1TiLY SA`tPLlhl:: Ir,STr`UCTIJM113-L.~.u, Pu X,
<br />EPA Form 3320.1 106-951 Previous editions mey be ueed. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) JUv LG/ `~O lOQI' 131 ~ PAGE IOF
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