|
PERMITTEE NAME/ADDRESS (/M.6 FarleryNa./!<ealm dDlg....tl
<br />NAME lYr„~uS :-i1+'IK~ C~i:PuKATI:ifN
<br />ADDRESS F u UU,( O':
<br />s '
<br />FACIIITy i:YrKUS tMPlht GlikFLiI:AT(~N
<br />lOCA710NLKAIu ':C1J 81ti2h
<br />/:TTh MIt=hAEL n. LuOtl;w. ,.EtNF;1kf -Lr.:a
<br />
<br />Form Approved.
<br />cG ~k JJ ., Pr-din TI-,Otr~~~or~71040-OQC4
<br />ApprovalI expiie~ ()5=31-98
<br />~:. ~~h: .2n 1(.47
<br />r - r[yAt
<br />i4ii, l,'K
<br />NOTE: Read InatNeUoro befor omp atin0 thia form.
<br />PARAMETER 13 Card Onlyl QUANTITY OR IOADINC~ ,. a ~ ~ rd Onlyl 4UANTITY OR CONCENTRATION NO FgEOUENCY SAMPLE
<br />l3I-37/ I!s-53/ 151-6/1 ~t ~ !38-451 /46-631 1546/1
<br />EX OF
<br />TYPE
<br /> AVERAGE MAXIMUM Yl MINIMUM AVERAGE MAXIMUM UNITS mz-sal A"ALY'ryS
<br />l54sal lsa7w
<br />~c~llJ$a I..IAL SAMPLE ,y»##+F'II ~ +#ii1,R#i .~*iIPiI# iti
<br />u 1 :i j V L V L: U MEASUREMENT _
<br />
<br />7~Z4S I 0 0 ~~ ~Pfi,RM4T:~: ~:~
<br />~..... ~ ,t,4~#ITI.'!PI?#.~.
<br />
<br />~ ~ ~:~ia>?f~~-#'~ :~. ,h,~ ~.. ~~;.~~+~: : ~. P{Ik Y~
<br />
<br />K~~ UP~T
<br />~I~:Thl r~(
<br />I ~ r+t~
<br />Y ii'lAu
<br />
<br />tFFluEtvi AIDS YA REQUIR~NIENI`.. ~ .. .......,.,,.....,..
<br />,, ` •",.. : .
<br />..
<br />. . .
<br /> SAMPLE
<br /> MEASUREMENT
<br />-
<br /> :~ n: -
<br /> .'
<br />i::PEiiMIT:
<br />.
<br /> .
<br />;F
<br />.:;,..,...,.,
<br />;REQUIRE.MENT.,
<br />~ ~ .~.
<br />x~:
<br /> K~.
<br /> SAMPLE
<br /> MEASUREMENT -
<br />~
<br /> "P~p
<br />t~E0U1NEMHMI .;....
<br />
<br />~"::w:; .:: r. i
<br />r V " ~'
<br />
<br />
<br />,...
<br /> :K,. . .....:.:..: :.:. .....,,. . ,.,.......
<br />.. SAMPLE..
<br /> MEASUREMENT
<br />
<br /> . , .
<br />. ~ SAMPLE:
<br /> MEASWIEMENT .
<br /> P..F,f~i~Q,4r:,i is
<br />
<br />1: ;;
<br />;. ,
<br />....
<br />
<br />
<br />.
<br />
<br /> SAMPLE
<br /> MEASUAEMENT
<br /> ~. ..
<br />'
<br />t F
<br />'
<br />'
<br />-.
<br />r
<br /> .
<br />.
<br />.
<br />.
<br />:
<br />
<br /> SAMPLE ~•
<br /> MEASUAEMEN'f
<br /> ;: .
<br />
<br />:...:... ~.
<br />NAME/TITLE PRINCIPAL+EXECUTNEOFFICER'
<br />' 1•cERY1FY ynDER yyENMTy off VLAjW~.THAT•.1 HAVE PERSONµLY E%AMIN
<br />AM FAMILIQI N'17?I THE II/EOg6tATTION SHO
<br />AITTEO HEREIN
<br />ANO BA ED AND
<br />SED ON TELEPHONE DATE
<br />'
<br />Richadd nAi11s :
<br />I
<br />MY iNOUIRY OF TNOSE .INpIN0UAl5 IMMEDIATELY RESPONSIB
<br />OBigNING THE INFORMATION; .1 BELIEVE TH.E SUBMITTEq INFORMA
<br />T
<br />CC
<br />q
<br />E'
<br />T
<br />N LE FOq
<br />TION IS
<br />J
<br />
<br />eF'
<br />I'
<br />'
<br />1
<br />I M
<br />' V[¢, A
<br />URAT
<br />A
<br />D COMPIEjE. 1- AA1 AWARE
<br />HAT .THE
<br />R
<br />SItINHCANiPENA{fiESFORSUeMf7fINGFi{LSEINFORMATION
<br />INC RE AAE
<br />LUDING
<br />~q]~ [;]Q-Z]~Z
<br />}~
<br />/Ty
<br />`~~
<br />.
<br />1VII
<br />OFIF?lf!I1
<br />a
<br />anag ,
<br />TtNNIE POSSIBNTY
<br />F H
<br />ND IMPN
<br />EE to
<br />f r
<br />t
<br />NMENT
<br />S
<br />C A
<br /> ap
<br />O
<br />E A
<br />SO
<br />. S
<br />U.
<br />.
<br />-
<br />' ND 33
<br />SIGNATURE OF PIIINCWAI EXECUTIVE
<br /> u,S.C. f rata. IPYnAT
<br />a. u.0~r dwAr mart.. mAr Nei.I. lxra Iq ro 1 /0,000
<br />TYPED OR PRINTED .rtswn,uinun wwiAVtnwnr of A,wArn6mmdra AV146 yAra1 OFFICEp Op AUTNOp12ED AGENT CODE NUMBER VFAR MO DAY
<br />!: V MMC.N l i ANU CAPLAHA I I V N V H API,T V I V LA I I V NS !/TB/a/BOLT I// efEeCD/genf5 09/e/
<br />~.I:LtauLC SilL1~~ LIMA ,aAlYtil FVK lOTKaZ4HK NKk(.IP tVc•VT-.YEL I.A.lr F•G 1VF FL;rt xEwuIKtMEhTS. uiL <.
<br />;,nca~c u,~ae SAHPIt ANALYSIS iccuUlkEU hf YiS[13iE SHEtN.15 UdScKYtL'. '~hTitLT ~AMYLING IN~TRUCTIGI~s-I.t....,
<br />P Form 3320-1 108.95) Previous editions may be used. (REPLACES EPA FORM; T-40 WHfCH MAY NOT BE USED.) J 04 64 f 401 UU I' 1.311 PAGE j OF
<br />
|