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PERMIT:.:: ..:.... ~.:: ., .:. . ~ ~::.::: <br />:.,: .: ~~ ~ <br /> <br />: ,. ::.~: <br />"" <br />.. <br />~ <br /> EQULR.EMENY <br />R. <br />, ... .::: <br /> <br /> <br />. .. ..,<,~. ..7 per: :.:. ... <br />.... <br />... <br />z.. .. . <br /> <br /> <br />.~.:. . <br />.. <br />Y. <br />:. <br /> <br /> <br />,:...;. <br /> SAMPLE -! <br /> MEASUREMENT r . <br /> <br /> <br />:..:~~~PERMLT.. <br />::r ..::. <br />.:..:....:~,ts , <br />4:.,.;y ::::::.:~t:.:::~:. <br />.. <br />I ~ . <br />.:REQUIREMENT: .. - . ...:.:.: <br />.. ........ :.... <br />_ , ......y <br />.. <br />T <br />; . ~ ~.. <br /> .aw.: ._..,:. .:.. <br />. .:;.. ..:.,........ <br />.. <br />i <br />...... , <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENKTY Ol: <br /> <br />T <br />T <br />E iA .HAT I.NAYE'PERSO <br /> <br />1 <br />I ED H <br />TO <br />5 <br />B NALLY ExAMINED IWD <br /> <br />EREIN <br />AND BASED ON <br />TELEPHONE <br />DATE <br /> <br />P <br />Ichard Milla INFpR~ <br />; <br />AM FAMIUAR WI <br />H <br />H <br />A <br />N <br />}1 <br />M <br />MY INQUIRY OF TNOSE :7NDlNDUAL4-IMMEDIATEG.V RESPON4BLE FOR <br />TME SUBMITTED INFORMATION IS <br />OBTNNING THE INFORMATION <br />1 BELIEVE ~' . ' <br />/ <br />/-> <br />/j <br />. , <br />. <br />t AM AWME TNAT TNERE. ARE <br />TgUE <br />ACCUMTE ANO COMPLETE 1/ ~ ^~ <br />~ <br />_ <br />1 <br />, l <br />l M <br />E <br />t <br />i . <br />. <br />BMITTING FiLLSE INFORMATION <br />INCLUDING <br />T <br />F <br />R S / <br />/ <br />~ <br />anager <br />nv <br />ronmen <br />a , <br />SIGNIFICANT PENAL <br />IES <br />O <br />U _ ~ <br />U <br />Z 8 <br />99 <br /> THE POSSIBILITY OF FINE MID IMPNSONMENT. SEE 18 U.S.C. E 1001 AND 77 F <br />E <br />T <br />E _ T. <br /> U.S.C. 1 1316. lPxWelr. uW NuF uarlma nwr ,hcAd~ rows w ro ! IO,000 SIGNATURE O <br />Mi1NCIPAI EX <br />CU <br />IV - <br />TYPED OR PRINTED w>m..im.n inpYaFrwrrt Plbnrwnemontlla uMbYAUAI OFFlCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (RS/sr~nce ee srrscnmenrs Here/ <br />.,~1TLEA~yIt SULIUS Llhil WAI'YiU Fox lUYt<rL4Hr1 PKLCif/ cYEIIT'~t:t-I.A.3. ?G [VF Fuk ntuulktMtlTfS. i:ll v <br />~kcASt l,kAd SAMPLE ANALYSIS iitllUlitEil (F YISI~LE SHEEN 1S UbSch Ytli. ~k ThiLY SAHrL 1hG Ir:STNUCTIi'N;-I.L.dF <br />N r <br />EPA Form 3320.1 108-961 Previous editions mey be used. (REPLACER EPA FORM T30 WHICH MAY NOT BE USED.) ~ ~ PAGE OF <br />UU146/YbiUl)1-1'911 ~ <br />