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PERMITTEE NAME/ADDRESS (!nclvde Fanliry NamNLocation i/Differenq <br />NnME PICRETYIfiE PACCESSIYG, LLC <br />ADDRESSYEY f:LR MIYE <br />1311 HAE6TYCOC LANE <br />FACILITY EVANSVILIE IY 47711 <br />LDCnnof~ESTCN CO 81091 €R( <br />ATTN: AL PERRY. CAbPGFA <br />Form Approved. <br />OMB No. 2040-0004 <br />M I Y C A Approval expires 05.31-98 <br />(SURA SF) ` <br />f - FIdEI LAMAS <br />AUNCFF FC6C 4/FUFCAICIFE AIYEF <br />v '~ NC C]~CHlFCE +~_ <br />`~ NOTE: Read Instructions befo com leting this farm. <br /> (3 Cerd Ony) QUANTITY OR LOADING (q ) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER 46-53) (Saar) <br />~ 45) (4&53) (54-Br) EX OF TYPE <br />(323n AVERAGE MAXIMUM Ui~:, MUM AVERAGE MAXIMUM UNITS t61-m! ~fi45B)$ 69-70 <br />PH SAMPLE ,~r,-,`•,rt -.,, .,. -S~+tv.: ( ~~) <br /> MEASUREMENT <br />~ ~~ <br /> ~ ~ <br />EFFLUFirT GiiCS`_ VP.LL AF~UI `~" ~ `~ ~ " ~•~~~ ~ '~~ <br />SCLICS, 'Iti.TAL SAMPLE 3~+-°.3r ~+++=>+ ~yT~~>a .i ( 14) <br /> ; <br />S U S P E N D t J MEASUREMENT <br />0 U S ,) U 1 U V ~- - PfiRM{l <br />' - ~-- ` ". ~~ Y F <br />,;.. <br />` I . <br /> <br />F F' F L U F S T G R O S S Y A L U , <br />~R~9UIpEME[JT' <br />'."1` <br />~ ;; ;; ,. ~'~ <br />- <br />G L ~_ ~K <br />„~ <br />SCLIDS, SETTLEABLE SAMPLE ~~'~~*~ ~x~Tt~ ,-~~v,-. #~kT#': ( <<) <br /> MEASUREMENT <br />UU54S 1 U C Pk'RMIT Y' i+'n ~~~#~~ <br />EFFLUE't1 G!?CSS YALUt REQUIREMENT r *v;.;. ~; C <br />IhOh, TCiAL SAMPLE r.r..+= ~~ ~° ~:~=%~:='=: I ( 19) <br />(A `'' F E) MEASUREMENT , ~ r <br />V` <br />U 1 C U 5 1 0 ~ 0 ''~;pER ITnia <br />~ ,~ <br />~ ; " <br />~ , . 44~~ • 3;` _ ~_ <br />"° <br />EFFLUFMT GROSS YALLf AE l)iRNfi' ~~=` <br />~ :.~; <br />.'. ~ <br /> _ _ <br />CIL AFU :,r.EASE SAMPLE ~%~~*~ #5~~++ •r+:r+~ c.~;t, ( 19) <br /> MEASUREMENT <br />U3Sde i U 0 pERMIT: 9#~, <br />~ <br />' :'~ 4~A+~$~- ,~~"1!L7!$Ar= <br />~ $~ `~~'~'.-~-~ <br />~• <br />EfYLLf?.T LP,CS`_ VAIG -p~QUIR~M~NT ''" ~ <br />` <br />~ " _ <br />flCr, In CONDUIT CF SAMPLE 03) <br />1 ,'~~'~+% „..-.,- ..,.'•-'• <br />THttU '1FEATtlEKT PIA l.7 MEASUREMENT <br />5 C US U 1 U G PERMIT lf~ '~~ '~~'~ ' ` ~ %~ <br />~ <br />FFF'LUFti1 GACSS YALU R~QUTAEMENT . w <br />~ .~" ~ ' !CD '~-';" ,~ ~ ++~ <br />CIL A6L; r~FEA5F SAMPLE ++Y~~'~ ( 94) ,Y+.+-. „..,, -..... <br />VISUAL MEASUREMENT <br />a 4 u b 5 ~ u c `pEpMIT ~ '° ~ a+o- <br />°FFLUENT G:2CSS VA <br />UE IREMENT <br />~(]U ~+ = =C ~~~.` ~' r ' `~ '"„ <br />L , ~,. lC ,. <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED AND <br />N <br />D TELEPHONE DATE <br /> AM FAMILIAR WITH THE INFORM <br />INQUIRY OF THOSE INDIVIDUAL ON MY <br />ATION SUBMITTED HEREIN; A <br />D BASE <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br />1 ~e f r <br />r THE INFORMATION. I BELIEV E THE SUBMRTED INFORMATION IB TRUE, <br />'' <br />y <br />~ <br />•• ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE ARE SIGNIFICANT <br /> PENALTIES FOR SUByyIIITTING FALSE INFORMATION, INCWDING THE <br />Z `-r -r.r <br />27 /~ <br />O <br />7 <br />T`1 A, K ~ POSSIBILITY OF FINE AN6IMPRI$ONMENT. SEE 1B U.S.C. 41007 AND 33 U.S.C. $ NATURE O PRINCIPAL EXECUTIVE ~ • 1' 11 / ' <br />ED OR PRINTED ~m~ml~~~ ~~ bGe wesen 8~mm~tl~eno5~ finev up ro fro,aoo en0 0. <br />ymrs.) OFFICER OR UTHOR12ED AGENT <br />NUMBER- <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relarence eR artachlnents here) <br />3U DAY AVERAGE IS E]GF.EST MCYTHIY IYG. DUAI6G pEA1CD AEFOATFD. CII E GREASE - SEE I.E.1.D~ F. ~. T5~ E <br />TCTAL IRON LIMIYP 411I BE YAIYFD, jYD SETTLEABLE `_CLIDS LIMITS AFFIIFC FCA <=1GYF.I4Yi EEECIP:E~ExT-°ETT. <br />CP~1 ~orm 332L- ~ 5) revlous a itions may o be use • C RM -4 I Y A <br />. OOg06/990716-j52};.:~~L,"' 1 <br />