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PERMITTEE NAME/ADDRESS gMrAFerd^y NaWla+nm dDlgi.+nQ <br />NAME SEdiC.4 ..^.06L COMPAaY <br />ADDRESS L) H A .I ,~, R ~ <br />NALUE;1 CO d1G39 <br />FACILITY <br />LocAnoNdAYDiN CO 81tr30 FRI <br />ATTh: G. HUL EP.Jw;:, ~=tIL'.tAL HA`lAi:;:R <br />Form Approved. <br />r.cuTe r..T TrsTItiGD"~:,Ne•2O44Aooa~ <br />( ~, f E F a V) APProvells~plr4 ~06-3 <br />F - FIlAI. <br />"INCH <br />NOTE: Raad InstEUCti«a batora cemplaUnp thin form. <br />PARAMETER !3 Grd On/Yl QUANTITY OR LOADING ~ !t OnlYl QUANTITY OR CONCENTRATION NO, FREDDENCr SAMPLE <br /> (4653/ !5461/ 3gJ5 !46531 (54811 <br />EX DF <br />TYPE <br />l31-371 AVERAGE MAXIMUM UNITS INIMUM AVERAGE MAXIMUM UNITS lsa.sn ANN.rGrs <br />!µ6g1 169-701 <br />DU ~ A N4 ACi <br />C c n I O C n P H N I A SAMPLE <br />MEASUREMENT r4: LSO#fi IX;<K: ,r^.p <br />~. .• `^ <br />~' ~,/ V q(yt,.:^:p uf, :, :`:~:'~ ( ~3} O <br />36 <br />' PNb <br />TAI:Sb 1 G U PERMIT fsAt7161toir. +A4t??f4E` 'SI lUU AFII?7A111 ^~xtYi=}>'+.. 'Eli- iP.RB <br />6FFLUf:NT i;itOSS YALU 'REQUIREMENT r,;..;~ ,I~j yALt;¢ CcNT .' h <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~•:::~: <br /> REQUIREMENT ~ ~~~-~`~'~"~ ~~~~~ <br /> SAMPLE µ' <br /> MEASUREMENT ~' . <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />'REQUIREMENT' <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENUTY~OF LAW THAT I NAVE PERSONALLY E%AMINED AND TELEPHONE DATE <br />AM FAMILIM WITH THE INFORMATION SUBMITTED HEREIN; AND BASED ON <br />MY INQUIRY OF THOSE INDIVIDUN.G IMMEDIATELY REBPONSIBLE FOR <br />OBTNNING THE INFORMATION, I BELIEVE THE aUBMITTED INFORMATION IB <br />TRUE. ACCUMTE AND COMPLETE. 1 AM AWARE THAT THERE ARF (Ej,- ~. <br />~ <br />07 <br />aIGNIFCANT PENN.TIFe fOR aUBMITTING FALSE INFORMATION, INCLUDING ~ <br />~ <br />THE POBSIBILITY OF RNE ANO IMpRIBONMENT. BEE 18 U.S.C. ! 1001 AND 3J <br /> <br />00F1 <br />MN~Ad+Fxw+IproFI0 <br />f 13ta <br />-FM+P +6NM1+m+ <br />V <br />B <br />C <br />lA <br />Wtl <br />K gIONATURE OF Plil PAL E7(ECUTIVE <br />AR A <br /> <br />TYPED OR PRINTED , <br />. <br />. <br />. <br />. <br />x <br />r+u <br />w <br />E <br />«wc+.r..•hw~.hw.'s+.~+~FNa1w..+e mma.. rlss Yrn! <br />OFFICER ORA ORIZED AGENT <br />CODE NUMBER YEAR MO DAY <br />GOMM[NIS ANU L:AYLANAIIVN Uh ArvT VIVLAIIVrvD IIre/9lenCl el/elreCOOro/ns ns/p <br />Sk.S PAfiT i. H.4 FOH GETdILS OF TEST P60CFDURE. BEPCP.T L'J'+'c ST CIIU7ICF (`. ~FFLCa_!T) rHICH IS L°TriAL TO <br />7U: OF TdST OHGARISI!5 (LC~U) AND ATTACK ACUTE TOXICITY :'.ST HEPCFT FC`r TC ^•F.. COPLES OF ALL <br />IN"')FM (1TTIlN "7f"T HF' cFAT Tf~ FDA <br />EPA Form 3320-1 108-961 Pre~ioue editions mey ba used. IREPLACEB EPA FORM Td0 WHICH MAY NOT BE USED.1 0 0 G 2 4 / 9 7 1 U 31-151 3 PAGE tOF <br />