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PERMfTTEE NAME/ADDRESS p~bsA•,byAL+/Lxum IJD,finu) <br />NAME ~~ ., _~., ., ,-I,~ - <br />4.~.I ctw.;c <br />ADDRESS +: `~ N L ~. ° I '. `~ <br />Tn Ir.~I uT_.~ Ey I. <br />111 t.+.-~ ~ J ~~ ~~ <br />'1.._~+7~ ' 1_i7 <br />FACILITY != yr .. '. /', I.\,C r/~-~ 17'11 <br />loCAIWN,rr:=:r- ^^ '+~.~._. FRI <br />Form Approved. <br />~r.rr ~ ,OMB~NoC 2040-0004 ~ <br />r ~ ,. ~ Approve, e}cRireB,05-31-96 <br />(' <br />}' - ~ ~ -'. <br />y T,. <br />NOTE: Reed lOfwctlorr Mfare eompletlnp thM fam. <br />PARAMETER !3 ord onryl QUANTITY OR LOADING N Card ontyl QUANTITY OR CONCENTRATION NO. FREDUENCY SAMPLE <br /> <br />l31-371 /46-53 /54-61 138-15 /4653 /5L61/ <br />EX OF <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS s-s.T, ANALrsIS <br />/1'x4661 l59-701 <br />~. SAMPLE ...... r;F CCY ~.~~, .. .. _. "rRitt ( ?~) <br /> MEASUREMENT <br />1;:~ ~~:/ 1 ~ ~1 ~ .PERMIT G3~:'riri~R. .t.sY~:~-9'.9 <br />.. 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'; A1.'Ir ~gEQUIREMENTf ... .. ~ : '.'::.'; ~: '.~.NST .~. 1170: !!Cc^ '~ .. . <br />NAMER'ITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY Of LAW THAT I HAVE PEABONALLY EXAMINED AND <br />AM FAMILIAR WITH THE INfORMATION BUBMITTED NEREIN <br />AND BASED ON TELEPHONE DATE <br /> <br />I ~ <br />1 ; <br />MY IHOUIRY OF THOSE INDINDUALB IMMEDIATELY RESPONSIBLE FOR <br />OBTNNING THE INFORMATION <br />I BEDEVE THE SUBMITTED INFORMATION IS <br />f v <br />, <br />/' I ~~ ~ , ~ <br />~ <br />' <br />~ TRUE. ACCUMTE AND COMRETE. I AM AWARE THAT THEAE ARE <br />SIGNIFICANT PENALTIES FOR BUBMITTNG FAIRE INFORMATION <br />INCLUDING ~.~ ~ <br />~ .t}-r <br />1 , ~ + k <br />z ~1~ 2? <br />~ 55 ~~ <br /> <br />/L. <br />~, „ ~, : <br />THE POSSIBILITY OF FNE AND IM%BBONMENT. BEE 18 U.S.C. 1 1001 AND 33 <br />SIGNATURE OF MIINgPAI EXECUTNE ~ u <br />- - <br /> U.B.C. 1 rate. 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