PERMITTEE NAME/ADDRESS On<l,d. fw'11fryA'awe~Ltt.nw yoA.e,o
<br />NAME ~.YY~I:~ r?tYIKt I.UKr'L.~AILUN
<br />ADDRESSI. L, DLX 62r
<br />4iiA I ~
<br />.' #:
<br />F d
<br />
<br />A wTVUYPkIf$-:E,lIP.IkE GiiidPikATIGN
<br />LOCATIOf~~AIU - ~L ~It„7
<br />A T TIy iMiCHJ6! :%w. I ilul :.... .:. A.LaeI hr..v
<br />
<br />fR
<br />Form Apppproved.
<br />S~,1ILS ~N ;.TKC:~t~F~~R~7n2~ col:
<br />A di0 ~. iies OS- ~T-98
<br />SUUK ~n 1~_~.7
<br />f - FINAL
<br />Hlh(JK
<br />«~:... /yam U(SCMgkGE ***
<br />NOTE: Reed Inetrueuane before completing 1hM form.
<br />PARAME~E~r. l36r00n/yl QUANTITY OR'L nlyl QUANTITY OR CONCENTRATION NO, fREODUF NCr SAMPLE
<br />131-33~1f1 -t 144531 15b611 ~ 38-151 (46-531 154-5I1
<br />EX
<br />ANUrsls
<br />TYPE
<br />.a,~; _ AVERAGE MAXIMUM ~. N6 INIMUM AVERAGE MAXIMUM UNITS my-s7i 15.f-5g1 !5&701
<br />lh ,: SAMPLE
<br />MEASUREMENT
<br />~ ~ ,. {It.M..,: ,y:,..:Ar+<
<br />~ ~ 1tr,..f:Ai~r
<br />f7 v>~"~
<br />b 12
<br />O
<br />Z5
<br />~~6
<br />U4UG 1 U U -;~r:.P
<br />•=<>; rt:":. ... .:....
<br />:`.?I!d!i#ik1~'!R;. ?'.:'F~~`~l~F?1P:;;IR 4~ ~ ~~:.
<br />~ ~;::::
<br />':ir:#~4#+F~ .U. ~ ..~KLY., :k~l~. .
<br /> ... . ~.2-:'.'
<br />LLIUSr rr;tAi
<br />~PtnUEli ''
<br />l LE
<br />MEASfjRE(u15t~IT• r.~ *o** y,
<br />~ ~ ,, *~*aa,
<br />~ ~~~
<br />~ l9 to
<br />q0
<br />G~~
<br />,
<br />:
<br />.„
<br />SIX! ..
<br />.
<br />~rr#~?In1
<br />.:
<br />:
<br />:>°
<br />,`;+t-i~*~*:
<br />5
<br />.,
<br />;a...,::;..:
<br />-.
<br />ki:GEf'
<br />kA3 : .
<br /> . ,
<br />.: .
<br />.
<br />
<br />` ,
<br />x .
<br />~
<br />'[L AI~U ~kEASE
<br />kcl.h tAfk-GRAV Mt TH sa PLE.~'
<br />MEASUREMENT ~,~~-lr,**r +r++~r~r . **#~r:r[~ .~..+<v~x+ ~~ I~~ O CIA N~A
<br />'L.~7b I 0 0 ~:,::. ..,. .. .:k+?1*ik..:....
<br />. ~ ~aRtDr:±~~~ll-.~+.k. *a ~ ~.!N>(.#*Ir~~ ~~ a***ifi~~ 10, .
<br />:
<br />,F....::~::.
<br />~;. ~ ~:N~~.j:N: 1.tA~~
<br />.
<br /> ;IiEQUIRENIENT: .
<br />~ «r~ri~ ~ .
<br />.
<br />:
<br />~:,r~ .
<br />Fi;N .SAMPLE r#ti~#*+k .,t ~~* (<r::{a:<$
<br />~ l9
<br />:
<br />S
<br />I.IAL KcI.L.VkcIIABLE MEASUREMENT
<br />'
<br />~ ,,,,. i
<br />.." pI~ 1 . 12q(3
<br />U'r~J i D : 0 ~: :.,.~~ ~ MIT'
<br />.' .:.
<br />~*##~z# ~..' ;:': ~
<br />;: *,< **a~a>it~. A:1 R~.f?41'JKT .. ;;. '
<br />(s .GIr/ Kalb
<br />_: AE¢UIREMEFIT. .
<br />
<br />
<br />~
<br />.
<br />,::.. ,.,
<br />::c,~.. :.:,:.
<br />„.
<br />
<br />,.
<br />,...
<br />
<br />
<br />.
<br />i
<br />
<br />
<br />.
<br />:.I >w . ;. ;
<br />
<br />
<br />...:. ,.
<br />
<br />
<br />:
<br />Ihl. ~ SAMr~LE y{.#tu# ~ 4rn-f+u I9 3
<br />JIaL RECUYEAJtAbLE MEASUAEMENT ~).~~~ Q ~I O 90 TCAS
<br />it; i4 i 0:; Q: <~• PlvRkiT::'.~ .:~iF*+zA#>r *:*~~~'' #r ">t*:~*ri* ):=;1 .ka;.. `'
<br />': ,:G~;/::; ~kb
<br /> .
<br />
<br />-L:..w, In CONOaiT Gk
<br />hKL l k[ATiyENT PLANT SAMPLE,
<br />MEASUREMENT
<br />prOJ;3CP q
<br />QI ~30 I ~y ryV#4{••,• #t<";'>}p ,•:•v:~v,r
<br />d 25
<br />1NSTA
<br />IUi1~U I Q 0` ~:7.:P,~,~AkT;`.'-
<br />" '64~.
<br />;.
<br />~ .RfPtiRE #~it*+F#~ +c><+t*tilA(*.:.. his#+FAr*. IM *t~ ~Ilk~ N5t'bN
<br /> pE.(Si11,gENT~NTr . .
<br /> SAMPLE
<br /> MEASUREMENT
<br />
<br /> ?.
<br />NAMERITLE PRINCIPAL,EXECUTIVE O~FICFA I cERTIFr u DER PFIALTY Of
<br />I
<br />F
<br />M
<br />i
<br />1 T
<br />N
<br />~ " aTI HAVE PERSO
<br />SUBMITT
<br />[D"H N LY E><AMIN
<br />ERAFILN
<br />AND BA ED AND
<br />SED ON TELEPHONE
<br />' DATE
<br />~ ~ AIA
<br />A
<br />IL
<br />WI
<br />1
<br />HE I
<br />QN
<br />MY INOUIRr Of TNOSE E
<br />:
<br />IMMEdATELY RESPONSIB
<br />Q$.' LE FOR
<br />L
<br />ZICiTif-fI MfIIS ~
<br />OBTAINING TFE INFORMAT/Oy ,
<br />t- BELIEVE THE SUBMITTED INFORMA
<br />M
<br />T
<br />T T
<br />E
<br />' TON IS
<br />RE
<br />RE i// -
<br />
<br />~
<br /> TqUE, ACCLRVITE• ANO COEA
<br />SlON
<br />IDANT PENALTIES FOR $ ]] AM AW
<br />E
<br />HA
<br />H
<br />~
<br />IN
<br />IA~TT1hL fALSE INFORMATION
<br />ro A
<br />CLUDING ~97 Ja70-27~ 4 ~~ 98
<br />Fnvironrnental tanager IF
<br />THE POSABILITV Of RNE MID I ,
<br />E
<br />NP11150NMENT. SEE 18 U.S.C. 1 1001 AND 37 SIGNATURE OF PIIINCIPAL EXECUTIVE
<br /> U.S.C. E 17t e. lANWS.. uWw IMw mnm. In.r irlcX.d~ rn.a ye ro J IO,ODD AREA
<br />TYPED OR PRINTED An6 wnlui.Nnr%IIMA'MYnNIr OI Mf1I1M1sTVINlAM6yAVa/ OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY
<br />COMMENTS ANO EXPLANATION OF ANY VIOLATIQNS (Rslerence e// ettschmsnfs herel
<br />rL~+n L1M/f APPLIES f., WM8INEU fL[,Mi FkUM OUir 021 & 024. JIL :. VrcLAai- ur<A~ jA;iPL~ ANALYSIS ri~uJ(Kt.!. Ir
<br />Y1~lbLc ~MECN IS UBSEkyEU. 4RTKLY SAMPLIyG [N STKUCTIGNS-I.C.or PG X.
<br />EPA Form 3320.1 108-951 Previous editions mey be used. (REPLACES EPA FORM T~0 WM CH MAY NOT BE USED.) PAGE OF
<br />OU518/YaluUl-I.il1 1
<br />
|