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PERMITTEE NAME/ADDRESS 5+d1O iACWON~/lsano~IJD16Erae <br />NAME SEHdCA CDAL C06PANi <br />ADDRESS DNAaER D <br />HAYUEY CO 81639 <br />FACILITY <br />LOCATION tiAYUdN CO R163U FRI <br />ATTN: ~. dUD DRJY^l, GE:~i:HAL RAVAGER <br /> <br />Form Approved. ~ ' <br />ACUTE YET TESTINGDMBJ~do.;o,;ag;oooa • <br />Approve eX i se OS-31-S(!~ <br />(S98R NY) 1~9L~ <br />r - PLNAL t«at <br />RINOR <br />C#r NO RISCHARGE ~_( arr <br />NOTE: Reed Inetrualone beforo eomplellnp thb form. <br />PARAMETER !3 Grd Onlyl QUANTITY OR LO <br />~ ' /a Grd Onlyl QUANTITY OR CONCENTRATION NO, FREOUENOY SAMPLE <br /> <br />191-371 (46-531 I5Q-511 /38451 !46-53 ' /61-51 <br />EX OF <br />TYPE <br /> AVERAGE MAXIMUM ~' ~~§, MINIMUM AVERAGE MAXIMUM UNITS (6309! ANAtrss <br />(6a-65) !6&701 <br />::SU 5 A' R 4SHR A SAMPLE R,'F S:~k .F ;r .-+-.. .Y, .. r., .'#+Y ( 27) <br />CENIODAYHNIA MEASUREMENT <br />TAr~38 1 D D HERMIT:..:: itF~:.F#:. <br />:: ~B."rkG'k'..!p Y~: <br />•.:.:. '':4i1:#*:#~: .....#fi.1k>l~#: l ER- '~''a'4T: ;It';~:..': <br />EFFLUENT GROSS Y-LUF ::REQUIREMENT. . <br />:. `' <br />:... <br />' <br /> <br />P.NT <br /> <br />''..: <br /> <br />.. . <br /> SAMPLE <br />MEASUREMENT <br />~~ 0~..~ <br />•~,~p~ ~Q <br />vle 1 ' ~ <br />c ' <br />~ , <br /> ::PERMIT. <br />REQUIREMENT '~ ~' ~~.:«-. <br />f~A ~Y~.~T : .~~ ... ~ <br />~~. :. ~ ::: _ <br />- :~:::i"''~~. t. <br /> <br />>aa> <br />j~` <br />:`?;•:a :~ <br />::`~~`J;:; ~',~?~;~;~', ~,: ~,; .:.~.~::.i.:~:.: <br /> <br /> <br />tt <br />:'.;'':::...;:~:::.. <br /> <br /> <br />. <br /> <br /> <br />: <br /> SAMPLE '^^" -'• ' - <br />~. <br /> MEASUREMENT <br />. -. - , <br /> .. :PERMIT.. .: <br />... .. ... <br />... ~ .::........ .. <br />..::a <br />: <br />s>~ <br />~ <br /> <br />:'': ~ <br />~::":" <br />~: <br />' <br />r <br />:r <br />~ <br />~ <br /> <br />'REQUIRE ENT <br />M <br />~ . <br />~ ~~ ~ ,. <br />.,..... <br />. <br />, <br />..: <br />: <br />` <br />:. <br />:.: <br />: <br />~ <br />~ <br /> . • : <br /> SAMPLE <br /> MEASUREMENT <br /> :: :. PERMIT: ~ <br />:•. ~ ~ .. ... <br />.... ..:..::... <br /> <br />.. <br /> REQUIREMENT: ~ ~: .. .:.:. <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> :~::.: PERMIT .~ ~ :~ ~ .. .. ,. <br />' <br />: <br />: ~ <br />~ <br />: <br />~ <br /> .REQUIREMENT: ~ ~ . <br />. , <br />.. .. <br />: <br />: <br />...::: <br /> SAMPLE <br /> MEASUREMENT <br /> :. PERMIT, ~ ~ ~ ~. <br /> ~fiEGUIREMEN7: . ~ .~ . <br /> SAMPLE <br /> MEASUREMENT <br /> .:.:'PERMIT'. .: . <br />~ .. .. <br /> 'REQUIREAAENT~~ .. .....~:.:~ <br />~: ~: ~ ~~~ <br />~'~ ' <br /> . <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER I CERTFY UNDFA PENN.TY OF lAW TNAT I HAVE PERSO <br />MILIM <br />TN THE <br />NFORMAT <br />ON SUBM <br />TTED H <br />AM F NN.LY EXAMINED AND <br />EREIN <br />MD BASED ON TELEPHONE DATE <br /> WI <br />I <br />I <br />I <br />A <br />MY INQUIRY Of THOSE INDINDUALS IMMEDIATE ; <br />LY RESPONSIBLE FOR <br /> OBTNNINO THE INFORMATION, I BELIEVE THE SUBMI TTED INFORMATION I$ <br /> TRUE, ACCURATE AND COMPLETE. I AM AWM <br />SI <br />OANT PF <br />TIES F <br />R SUBMITTING FALSE INF <br />N E THAT THERE ME <br />OMIATION <br />INCLUDING <br />+ 1 <br />L <br /> , <br />GNIR <br />N <br />- <br />O <br />THE POSSIBILITY Of RNE AND IMPRISONMENT. SEE 78 U.S.C. L 1001 MD ]9 10 <br />RE <br />EXE <br />NE <br /> U.9.C. 1 1 ]t e. lhlrleN. uMr Mt. AYNM1. IrI.Y heA.d~ rwa ye b r 10,000 NATU <br />OF gPAL <br />CUT <br />P11J <br />6 <br />TYPED OR PRINTED m6n nruirll.n mMm+~rorMwwnemenn.w6y..a/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference s// efrschmsnts nsrel <br />5i~ PAnT S. A.4 FDN DETAILS OF' TEST PROCEDURE. REPORT COYEST DILDTIOY (Y EPPLUENT) YNICN IS LETHAL TO <br />SUS OF TcST OR::ANISRS (LC50) AND ATT-C3 ACUTE TOYICITY TEST REPORT FORM TD Dt{R. COPIES OP ALE <br />7tiF6RRATiOY RUST RP SEYT T6 P.DA- ~ _ ~ ' <br />EPA Form 3920-1 108-861 . Prsviow editions mey be weed. IREPLACES.FPA FORM 7~a0 WHICN MAY NOT BE USED.1 OOD 6 0 V ~ 9 O 91 U- 0913,. PAGE 1 OF <br />