Laserfiche WebLink
PERMITTEE NAME/ADDRESSp~LFacWryNawL«mlon lJDiBfmmq <br />NAME LYh~KU.] i.N'P1Kt CuKPL;rcATl~,v <br />ADDRESS (~ ET dUX bd <br />,~ LtiAiU CL tJ161a <br />FAauTV CYNKUS E~MF'Ikt CUKPUKgTIuN <br />LOCATIONL KA1lF GO 8162h <br />ATTN HII:HAEL :.. LLI(I LiJ VI. L, f-Nk Hdl ML.It <br />~~I/L ~1 OI':--11.1 <br />~U3k Nn <br />F - F1tvAL <br />Fonn NApproved. <br />OM~ L 20A(~-0004 <br />T t' Approver e~piiee OS-31r 98 <br />11 34t> <br />:.If+UK <br />NOTE: Reed inetructlora b a com letinp thle form. <br /> <br />PARAMETER !3 Grd Onryl QUANTITY OR LOADING :~ ~ . i' C6/d Onlyl QUANTITY OR CONCENTRATION <br />NO. FREDUENCr <br />SAMPLE <br />132-37/ (<653) (5661/ i38J51 !4653) !546/1 <br />- <br />EX OF <br />TYPE <br /> AVERAGE MAXIMUM UN MINIMUM AVERAGE MAXIMUM UNITS 163.69! AN'LLYST3 <br />/6658/ (6670/ <br />1L ANU ~KLASI: SAMPLE ###*## <br />I4 <br />#A#### ,,,; <br />`'f {aA{ 5: <br />{~~~ti<:. ti.{. <br />'r 1'~UAL <br />MEASUREMENT <br />~ <br />U YUbb 1 li; 0 :.;~,:PE,RM4T :.>tT~ ' <br />.~;~~`:~ak~C?~~:M! ~ ~~.:~~. .~;:. ., ~:.. ;~ ~ ~ 1 ': .P!t!:'::~;.: ::.. it##IBp# {F#L#/!1k#... {. {..F :~ ~NCE! I <br />Si1AL <br /> <br />c F F L U E N T G' V A REQUIREMENt~. <br />....:.:..:..::... ::. . <br />::.. ... . ....:: <br />.. ; :.... ~ ` •.::'~. <br />::.:: : <br />.'..>::, •. <br />.~ .:.:.c;...;';~. o..;:. <br />._ . <br />.. <br /> <br />.. :. <br />4# {~.} <br />(III . <br /> SAMPLE <br /> MEASUREMENT <br /> .: <br />:.,. PERMFT: ~,. ....:: <br />,, <br />,,. .:. <br /> . <br />:REQUIREMENT <br />.: ~ <br />~ ~ ~ <br />: g:: <br />~.:~ : ~ :::.:.;J:: ~: <br />'?z ~ <br /> <br />:. : <br />~ : <br /> <br />~ <br />. <br /> .. .. .... .. ... .. .... ...._e- : . .~ <br /> SAMPLE ~ " <br /> MEASUREMENT <br />' ':°PgRMI. <br />~ <br /> ~PEQUIREMENT~ '~ .. ~~::.: ~ ~ <br />~ .. <br /> SAMPLE <br />..- MEASUREMENT <br />- ~ <br />_. i~:PER.MIT:.. r~~ <br /> ?REQUI~IEM.EN'j <br />.. ;.;. . <br />...:.. <br /> SAMPLE <br />-~ MEASUREMENT <br /> ..:: ~:~ PERMIT;:':;. . :..;: . ~ ... ~ ~ ~ ~:. :~ ~ .. <br /> gE:ailiREM~NF'. <br /> <br />~~ ~ <br />~ <br />,.. <br /> SAN1PlE " <br /> MEASUREMENT <br /> ... ~PE.. NIIF,...~": °~ .. ~ <br />... .~ .. .. <br /> ~t1EQU~~,EME~<,. . r ~ ~ .. ~ ~ ~. <br /> SAMPIfi <br /> MEASUREMENT <br /> ?::. ~~ r..a <br />. <br />P.E ..M ,}:.., . <br />.. .::.: ... <br />- .... ,.. . : .:.. <br /> • .;...:. <br />' <br /> ... .. .. ..: .:..F.. ..... . ..:.. <br />.. ... ... . <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I+CERTIFY uuOER PENKTY OF lAW THAT I HAVE PERSONALLY E%N.11N <br />AM FAMILIYJI WITH THE INFORMATION SUBMITTED HEREIN: /UiD BA E0 AND <br />SED ON TELEPHONE DATE <br /> MY INQUIRY OF ~ THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> <br />Richard Mills OBTAIRING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS <br />D COMP <br />RE THAT TH <br />T <br />TE <br /> <br /> <br />Environmental i,lanager nuE. AauRA <br />AN <br />LETE. 1 AM AWA <br />ERE ME <br />SIONIRCANT PENKTIFS FOR SUBMITTING FALSE INFORMATON, INCLUDING <br />THE POSSIBILITY OF RNE AND IMPRISONMENT. SEE IB U.S.C.110p1 AND 77 , <br /> <br />V <br />BIONATUIIE OF PIIINCIPAI EXECUTNE <br />(t~]Q S]Q-Z7~Z <br />` <br />R <br />2~ <br />9B <br /> U.S.C. S tats. nRxWd. u+sr Err mnma my 4spdA Fnr ~q ro f/0,000 AREA <br />TYPED OR PRINTED .rMwmahsAn Lnpdasnwrr olbMrn 6mmN,W6yrial OFFICER OR AUTHORIZED AGENT LADE NUMBER YEAR MO DAY <br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS 1R67erenee e// ettschmsnts here/ <br />.,LITLtAdLt ]tiLIJS LIMIT r1A1VtU FD I{ lUYIlF24hly r'KLG1F' L'VtNI-$tt 1.A.16 P~ IYF FG+•: KtiUIREMENTS. i/lL c: <br />~ktASt UnAb SA+~NLt AIVA.LYSIS KE~U1ktU 1F YiSIbLL SHttN I, UoSthVcO. GhTnLY SAMI'L.TNG INSTRUCTILN~-1.(..•.. <br />EP Form 3320-1 108.951 Previous editions mey be used. (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br />0019y/4o1L)U1~13I1 i <br />