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PERMITTEE NAME/ADDRESS Q~b Fr1lrry NrWLeraUm (/DrlJGnvl <br />NAME l-Yr~reUS r_;1Plb'.t CUrIPUi`ATiUN <br />ADDRESS {: ,J JI;X 00 <br />G!xraIE~ GU &1,G2b . <br />FACILITY ~YPItUS. ENRIRE' C(~~A-C~ItAT Q1,;-", ` <br />LOCATION~RA IV ~ ` .:. ,.~ ~!~~'~, , <br />:.ITN MII.HAEL w. LUULflri." ~ElliiR~'~-;~ <br />Form ~AQp~proved. <br />L ~~'- }l/ Cii- r1A TUG~~I-I~~O~t-Q 41. <br />Approve{ e~t j'y d 531.98 <br />SLdk Nw 1C <br />F - FINAL <br />N i Nl~li <br />"*015GHARCE~ +++~ <br />N d Inetructiate bel eompletin0 thb form. <br />PARAMETEq" r3'esrd n 1 ANi1TY ~RtOADING <br />- dOryyl:'.4UANTITY OR CONCE N NO. UDdOY <br />FREO SAMPLE <br /> 71G531 '. ! 611 <br />~ h38' S7 !46531 !54611 <br />EX O <br />TYPE <br />l32-371 ~ ANALYSIS <br /> ' AVERF{~E <br />" ".;tMA9(1NIUM UNITS Mlfyl " <br />, _- ~ AVERAGE MAXIMUM UNITS !sz-ssl l50-551 /64701 <br />~L.LIII~F luTAl SAMPLE $#;4kf '. ~I 1Y~*a 91#* <br />~ 19 <br />iL V L ~ <br />1 "> j MEASUREMENT ~ 1; , <br />L <br />l ~ t 9 S 1 d D YY~~i ; P.::.tw~l~:.,: ,• .»:~>w* . '`~+l~#~;±~1 .. #>k K L F U ~ .:': OPT.( 01~1;I L ~';<t Y , f~.A$ .: <br />-FrLUL-NT <,R YAl E ..,..:,::::.!!Tk!E..N:.,, ::;.,.. ~:..:;;:.:.: <br />,:: ,>'eo ~ .. <br /> -. SAMPLE <br />~ <br />~ <br /> NA,EASUREMENT ~- " ' •.' r <br /> <br /> ~. <br />;;:'t~HSylfiiyi.; ... s <br />::. <br /> <br />7.: . <br /> <br />: <br /> ; <br /> SAMPLE <br />~ <br />"" M~A$YREMENT + <br />- <br /> =¢ <br />".` w~ <br /> <br />' ~..: ~ .. .,, " . . <br />.....: <br />;:a:'...: ~: .r..: . <br /> <br /> <br />. " <br />~' ~ .. ~ .. <br /> <br /> <br /> <br />..: <br /><. <br />_:. <br /> <br />~ <br />E1~4...:. tilE~i <br />..:.. . . , : ... <br />' ~ ~~ ' SAMPLE' " <br />" ~1'~ <br />, :- - MEkSUREMENT <br /> <br /> 4U~EMETIT .> .., <br /> <br />>~ MEASUREMENT <br /> <br />.. <br />,,..y~ _. .. , <br />.,v... <br />, <br />~ •.....::. . <br /> <br />Y,-. <br /> SAMPLE '' •~ <br />~ <br />. q <br /> <br />. ~ <br />NJEASUREMENT <br />~ . <br />_ <br />.: r <br /> M!~" 1'" <br /> <br /> <br /> SA Pt <br />` <br />' EASUREMENT ~., <br />•y ~ , <br />:a:r:..:.:.'. <br />': <br /> <br />NAME/TITLE PRINCIPA XECIli1V8.OFFICER I. ERTTIFY UNDEfl PPENALir <br />AM f.AMILIAq WITH THE 1 ATARI YEpERSONAI{,v ExAMI <br />MILTED HEREIN; AND B NEO AND TELEPHONE <br />ASED ON , GATE <br />• MY iNOUIM OF THOSE N INIMEOIATEEY RESPONSIB Lf~ FOR <br />F.icFia rd Iti~1 IIS OBTIJNING ~ NE IpFQRMATION <br />1pUE. ACCURAT AND ~OOM , F' Tf{E 5 BMITTEp INFOpM <br />PE M1 MMARE THAT TNE A710N 15 <br />flE ABE <br />Fn vironmpnial Mana er SIGNIHCANT PENALTIES fOR <br />THE POSSIBILITY OF HNF AND SUIMITTIp FAt5E1NFOH/~ATON, IN <br />IMPNSONMENT. SEE to U,S.C. 1 1001 CLUDING ( ~ <br />AND 7] ` 97 ~ 87~-~ 7 ~ 2 <br />F <br />A <br />E <br />VE n <br />4 27 9 . <br />U.S.C. 1 t]fe. IIi~rAi. InNr tlwr moms mFy Ax.'bdr rn.. w ro FIO,000 <br />TYPED OR PRINTED .rla or rnFAUm.ttl+wlovt.Ae Plan...nsmnN,rMSFFAraI SIGNATURE O <br />PFIINpP <br />L <br />7EECUTI <br />OFFICER OR AlfT110R12ED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND.EXPLANATION OF ANY VIOLATIONS (Re/erence sll errechmenu here! <br />,cITLcA~LE SUL1~5 LIK11 :]AIVtU FUk l0YRR24tiK PiEGIF £YtNT-yc~ I.A.3/ PG itl, Furl Kt4iiIREf1t.~T5. l.Il .. <br />L.rcc45E ~ItA6 SAt1PlE Ar.ALYSIS IiEaUiREU iF VISLdUE SNEEk [5 USS~~YCU. :1hTriLY SAMF'IENG IrvSTRI,CTiti:N,-l.i.._tE <br />EP Form 3320-1 108-951 Previous editions mey be used. (REPLACES EPA FORM T-40 WNICN MAY NOT BE USED.) QUy63/961llU 1- 131 1 PAGE lOF <br />