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PERMI7TEE NAME/ADDRESS pnerb FrWryNrr/famlon VDlEa...q <br />NAME t,Y~rtL.S ttlF'lt?t Cu~r'ur<ATIuN <br />ADDRESS P U D L,C b J <br />y~~AIU CiJ d161~ <br />FACILIF~"~YVRt.S tMN11c Ciii:PUr,ATILh <br />LOCATIONCkAIt, (,v fjlb2h <br />.+iT~. n1LMAEL n. LUULS,r~. ctaFk~t ~Ir.4 <br />iLn`~ G `J iv-'> I ii T'-~ <br />Si/dR Nn <br />F - FINAL <br />Form Apprpoved. <br />~IY~E~IILoI1~40 0404 - r <br />Approve`` e><pIr3B OS°31-98 <br />1L34~ <br />M 1 I+OR <br />##k NL L'I SCiiAkir E\~ •t a'i~ <br />NOTE: Reed Inetruetlarn before co btinp thb form. <br />PARAMETER 13 Grd Only) QUANTITY OR LOADING ~ 1~ rd'Onlyl QUANTITY OR CONCENTRATION NO. FREDUENCV SAMPLE <br /> 14663/ /5F61 : ~ l38~6 14653 61-61 <br />~ DF <br />131-37/ <br />~ EX <br />MALYSIS TYPE <br /> AVERAGE MAXIMUM ~tJN ~ MINIMUM~ AVERAGE MAXIMUM UNITS f67iJ1 i64.6B/ t6&70) <br />~LL1JSr TuTAL SAMPLE ##ffa# ~k4k### '*#*{II~f IY <br />U 1 ~ ~JL Y t IJ MEASUREMENT <br />T L ~ y ~ 1 U 0 :~:;: '?E..RNIIT:...".: ~. ~ ~ ~:«!$'+L~f fli~liil : ~ ' ~; akfl;Krk?1rF v 1 # :'.: <br />~~~ <br />~ <br />?IF : ' <br />:~~'R~ <br />~~C[R~~~ <br />; <br />4J[STID~LtR~4 <br />~ <br />~~~ <br />~TetLY~ <br />r~r;As- <br /> <br />LhrLUthT t <br />r S VALU 'REQUIREMENT; ~ ~.:.. .... :. <br />~ <br />; ; <br />;.,-... . <br />' ~.. <br />;~. <br />`. <br />'i . <br />; <br />: . <br />S <br />,n <br />L :...:::. .. ... ##>kv _:::;~;.t %.~. ':; <br /> . SAMPLE _ <br /> MEASUREMENT ,. .'. ~, <br /> ~:. <br />~~:~::~ PERMIT ~ . :. .' ~.. ~ ~ ~ ~ '~i~:: <br />:' :.:~ <br /><s;::~:~ <br /> . <br />~~REO <br />UIREMENT ~~ .. ~ . <br />~~..~. ..: ~.:.:::;:::e..~;. <br />., . <br />:.... .: <br /> . <br /> SAMPLE <br /> MEASUREMENT <br /> ...:PERMIT ~ ~ ~ ~~ ~.. <br />.. <br />:.:'.: .. <br /> <br />'n <br />'+; . <br /> pEQUiREMEN7; ; <br />: ::. :r: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT. ....; :.... <br />.. :. ... <br />... <br />~ <br /> ~REQUIREMENT~ .. ., .~:':; <br />:: :. <br />' ~: ~`.:. <br /> sAMPLE <br /> MEASUREMENT <br /> <br />RE <br />UIRE <br />EN ,. <br />, ~ <br />~ ~ <br />~ <br />~ <br />:?` <br />':, <br /> Q <br />M <br />T ..:; ~ ~ . <br />s:~' . <br /> SAMPLE <br /> MEASUREMENT <br /> ~~~ ~ PE.NMIT ~ ~ ~ ~ ~~~ <br /> <br />NEt2UIRE6AEN7: <br />~. . <br />. ~: <br />~ :: ~: ~ ;: ,: -, <br />........ <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> QUIR <br />Ri: ENIENT .:: ..:.:-.:...;: <br />. <br />:: ; <br />;: <br />: <br />~ :~_ <br />`, <br />:, ::~:; <br /> . <br />.: . <br />.. <br />..: <br />. <br />...., : <br />: <br />:;:. ~:.. ~ . <br />: . <br />NAME/TITLE PRINCIPAL EXECUTIVE OPFICER I cERTIFr uNDeR PENUTr CF uw TNAT I HAVE PERSONALLY El1AMINED MD <br />AM FAMILIM wITN THE INFORMATION SUBMITTED HEREIN <br />MD BARED ON <br />' TELEPHONE DATE <br /> ; <br />MY INQUIRY OF THOSE INDIVIOUAL9 IMMEDIATELY REJPDNSIBLE FOR <br />Nichard Miils OBTNNING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br /> TRUE, ACCUMTE MD COMPLETE. I AM AWME THAT THERE ME <br />E <br />i <br />- <br />l M <br />t SIONIFICMT PENALTIES FOR SUBMITTING FALSE INFORMATION <br />INCLWING (~~Q <br />Z7T2 <br />a1 O ~i 7 <br />' (1~ <br />ETV <br />I <br />nnmen <br />ana er <br />a , <br />T <br />SSIB <br />OF <br />0 <br />E ~ <br />- _ <br /> HE PO <br />ILITY <br />flME MO IMPN8 <br />NMENT. S <br />E 18 U.B.C. { 1001 MD J3 <br />{IO <br />ATURE OF PRINCMA <br />EXE <br />NE <br /> u.B.C. r I Jts. lPnWeY. erv« err mror• nrr I+cAw IGr. w ro t IO,OOD L <br />CIrt <br />N <br />TYPED OR PRINTED .rrl ermuimrn inPVlrvnlrn olMMrnemplna rp Brrr..l OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAV <br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS /Reference el/errechments hero/ <br />~EITLcAoLC SL,L1liS L1kI7 PIAIVtL 1-LIK lUYnr[4nk' F~tL,IF% LJcNT-.iLc-:.A.3r PL IYr hlrll r,LJUIaEMENTS. LIL <br />,~nLwJt 6nAu x:111 F'Lt AtvALY~I~ rctuUlttEJ Ir VISIP.LL ShEEty 1S ~.~~:.-Vt D. Wr.TKLY SAMh'L IhG iNSTRUCT1iiNY:.`...'.. <br />/!- Y . <br />EPA Form 3320-1 108-s51 Previous editions mey be used. (REPLACER EPA FORM T-4O WHICH MAY NOT BE USED.) J U! J 3 i S U 1 U J 1- [ .S 1 1 PAGE I OF <br />