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PERMITTEE NAME/ADDRESS (IM,6 F.eeiry NwWLxanen dDl>linnq <br />i <br />NAME ~ . 1 ~ ~ '.:o ., <br />ADDRESS N `;'+ '~. 1 !'. !1 C 4 F <br />' 1311 3.~..,tw~...1 a.Y <br />~'~`+,'!f •. ~ E v t. ,, s v ~ Ile ?" 7"RTJ'?+t+ I AJ <br />FACam <br />,_. _. <br />LocAnoH p p, _; ; 1 q <br />~. L. Ps...~ CD H1J41 F <br />ATP(+: •, /'°NF;?AL N^N. <br />Form Approved. <br />u!, ., t\FF ~r1 ": '\ `,1 E•'1~~'NP~~Q40-~4f ~~^F <br />(S(:°R Sr.) APProvel~xpile~p~-31-98, <br />r - FI`?AL <br />`•r1:nR <br />NOTE: Reed IrwtructltNle before completing thb form. <br />PARAMETER l3 AYd Ontyl QUANTITY OR LO' !4 Urd Ontyl QUANTRY OR CONCENTRATION NO FREQUENCY SAMPLE <br />/32-371 146-53 !5461/ 138-451 14653 1546/1 EX of TYPE <br /> <br />AVERAGE MAXIMUM <br />MINIMUM AVERAGE MAXIMUM UNITS <br />/sz-a31 ANALYSIS <br />/64681 <br />169-7o1 <br />PN, SAMPLE ?:tr^:^ .... .,-..^ ( 12) <br /> MEASUREMENT <br />:lOq~!!) j () !1 PERMIT rCVk.410i4` <br />~ ~OE>y!p!~:Q1.-:.. <br />:: <br />.. 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IJ ~RE.QUIFtEM.ENT: ~.. ~. ~~. .t ~R §.T, 15~11..~;~ V'l=0 .. ~ :•:~~~k <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PFNKTV OF LAW TNAT I NAVE PERSONN.LY EIUMINED AND <br />AM FAMILIAR YgTM THE INFORMATION SUBMITTED HEREIN <br />AND BASFD ON TELEPHONE DATE <br /> <br />q ` <br />~"~+' ; <br />MY INQUIRY OF THOSE INOINDUNS IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INfORMATION <br />I BEl1EVE THE SUBMITTED INFORMATON IS p <br /> <br />!( I <br />/ 1 <br />` , <br />TRUE <br />ACCIIMTE AND COMRETE <br />I AM AWARE TNAT THERE ME , ' <br />~ <br />~ <br />'O '\ \I\-1 <br /> <br /> <br />1-l h r\ 6 C. ~' <br />. <br />. <br />SIGNIFICANT PENILLTIES FOR SUBMITTING fN <br />SE INFONAATION <br />INCLUDING <br /> <br />f <br />~) <br />pL~_ <br />7 <br />,7a <br />GPI -1 <br />O <br />I L <br /> <br />y . <br />, <br />THE POSSIBIOTY'OF R <br />E <br />D <br />PN 1 - 0 1 1 I <br /> N <br />AN <br />IM <br />SONMENT. SEE to U.S.C. f 1001 NID 3] BIONATUIIE OF PRINCMAL El(EC <br /> <br /> <br />TYPED OR PRINTED <br />U.B.C. f 131 e. R°Yll.le.. I/IAA dnr .btlm. nuY I'1[AnT1 A'IrF W ro 510,000 <br />rlsonrrirllnr iryv/mrwtW Mtww,emarNa rtl6Yfrsl IlI1VE <br /> <br />OFFICER OR AUTHORIZED AGENT <br />AREA <br />CODE <br /> <br />NUMBER <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />l-UMMCrv ID ArvV CAT'LXIYAIIVro VT ANT YIULAIIUIYD //FB/6/IDCI N/eRDCOnIMr9 DI/e/ ' <br />• L ^L• a ~! \r!a p -ry'\O nor. r <br />/. '.Y Y A.. l'~ C". ',./,;^''.LY A•/:. 17': .~C,1-: p'. aTL :"'F' - I. .1.L•, P. •l, ._ <br />r <br />1^ ., !, .,, 1,(~EIT'i v!(., ~/:, 'N .qIY°^, A'.p S; rl,:grlL. '!LI'1<. -.I'1im.; .u:..I"'r c,); <=7rfY' ~:J,s+ rTR('TD ..Y...1~._~, <br />='ll Elf: 1(tIT u1L1 q: 7ijVF^ P7t )1 x/94 )!1114 DYE^7D PVANT-CXP aIT lir TT"/4'IPhPI r4 PGA F vL'lTN NT • E Z ^7• <br />EPA Fwm 3320-1 108-55) Prevloue edltlone mey bs ueed. 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