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PERMITTEE NAME/ADDRESS (include FaciLN Nome/Location fDifferenQ
<br />NAME PI Cr.t'fwIF.k EFCCE55j4;,• LLC
<br />ADDRESSN ° e r. L Y. MIN E
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<br />FACILITY `~ >t ~ T~„ I / y y u 5 1 (~
<br />LOCATIOtyp,-.i t,ti CC biC`il
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<br />Form Approved.
<br />OMB No. 20400004
<br />~ I h i G Approval expires OS-31-98 ,
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<br />NOTE: ~tructions befor€ cdTnpleting this form.
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<br />[ (3 Card Onty) QUANTIlYO O rd Onry) QUANTITY OR OO ATI NO. FgEOUENC
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<br />TYPE
<br />PAHAMET Fi
<br />/ (6653) (5
<br />1 ~ (38-45) (46-53) - - (54-61J EX O
<br />(32-37J AVERAGE ~G~~
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<br />o ~ MINIMUM AVERAGE ~ ~ MAXIMUM UNITS
<br />fBY WJ aruaLYSls
<br />(6468)
<br />69-70
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<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW T}IAi I HAVE PF,PS ONALLY E%AMINED AND TELEPHONE OATE
<br /> AM FAMILIAR WITH THE INFORM ATION BMITTEOHER EIN; AND BASED ON MV
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<br />OY ~ [ ( ~-A ~ , A ~ h INQUIRY OF THOSE INDIVIDUALS IMMEdATECY RESPON
<br />THE INFORMATION, I BELIEVE THE SUBMITTED IN SIBLE FOR OBTAINING
<br />FORMATION IS TRUE,
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<br /> ACCURATE AND COMPLETE. I AM AWARE THAT TH ERE ARE SIGNIFICAM ~.(~
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<br />M N ~ A ~ c PENALTIES FOR SUBMITTING FALSE INFORMATION, INCLUDING THE
<br />POSSIBILITY OF FINE AND IMPRISONMENT. SEE 1B U.S.C. 41001 AND 37 U.S.C.
<br />SIGNATUREbF PRINCIPAL E%ECU IVE [p~
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<br /> § 1319. (Penettiav uMef These 57e(utes mey inclutle lines up Ip f10,000 end or OFFICER OR AUTHORIZED AGENT R NUMBER YEAR MO DAY
<br />TYPED OR PRINTED me,.imum impnspnmenl olbetusenbmpnrhs entl5yeers.)
<br />COMMENTS ANU EXPLANA I TUN V r ANT V IULA I I V rv5 (nererence eu anacnmenrs here/
<br />1U DAY AYLHAGE 15 h1Gt~51' CCNT(iLY [1VG. CUFiIAG FEFICG AEFCt7EC. CIL £ LhEA3t - SEE I.E.1.C• F. 4.
<br />EPA Form.3320.1 (0@-95) Previous edjtiogs,m@y~nofbe;lksed, '"" ~)E}ERLACES ERA_FpRM T-40 WHICH MAY NOT BE USED'). 0 0 00 4 / QO L ] ] I ^,~ E 1 ~ FA~Caa.. O.F
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