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PERMITTEE NAME/ADDRESS p,.ii4 Fr6gNaWLocsuon l/D)d..em) <br />NAME <br />l,)'r:~~tUj ~r~r'irt~ L;Jnr:.nigTlu.r <br />ADDRESSY U UL?. 6l:~ <br />LnAii, CJ tilb2b <br />FACILITY l.Yi'nuS c^""r'1Rt CiiKPLii<,~Tlki.w <br />LOCATIOtt:t A l u •r [i ',1'' l :!Z ] <br />a fLti MILNaFL ... I ;IiL i~.w- LFdCUai Mt:L <br />.}U J~ 1(F <br />F - FlNitl <br />MIh 1 <br />Form Approved. <br />T y o~n ro. zoao-oooa <br />App~o4rl a/zPiie~ CS-31-98 <br />1L!Y .` <br />L. K <br />ri`t".' iVi. Ul>l. ilAKliL .r i,y <br />NOTE: Reed irlettu0tloM bef • compleUnp this form. <br />PARAMETER f3' rd Ohly) QUANTITY O ~ OnNI QUANTITY OR CONCENTRATION NO. FIiEOUENCY SAMPLE <br />l31-371 1x6531 I5d-671` - ~ <br />! X51 146531 154611 EX of 7VPE <br /> AVERAGE MAXIMUM <br />. NIT'$ <br />+{, MINIMUM AVERAGE MAXIMUM UNITS <br />161.691 ANALrss <br />(54581 <br />(5&701 <br />LL1iiSr FATAL SAMPLE <br />' {,##t&,kp ###i<•: : -' ~ <br />~ <br />' VM#~[~jf 1`>: <br />I > >uL V c U MEA9UREINEN <br />F ~ 'i <br /> <br />(.~7~ 1 0 U <br />;:......E,rR~.~:::fi:;' _... <br />:::.?Ik~?it?11.`;~ .: <br />:::.:::..:.)-, ~#i:.~ <br />'~ <br />a•> <br />>att$#~~kd< <br />;t a:r'LirtT . <br />..P <br />:i i:~11i3L.. <br />T1LY i <br />eiAt) <br />' - R~QUl~E7Y1 <br />E <br />(rT;. .::.,~;:.s:.:°:;:;. % <br />. <br />: . . <br />,:.: . . <br />r L . <br />. <br />;... ..:. : ....... .... . <br />. <br />..:.:... ..: ... ..:: . .. u <br />.... <br />, <br /> sAMPI. <br /> MEASUREMENT ~ ~ ' ~ <br /> ~ <br /> ,~~ -; <br /> :NEAPlRErjF1E!±Fr:: .:.:::~.:':'::,h? :::.... <:;.;' : ^' :;: <br /> SA PLE <br /> MEASF~,REMEKT <br />.. <br /> ~ <br /> ' <br /> SAMPLE' <br /> MEASUREMENT <br />~ <br /> t?ERMt ,,. <br /> <br /> <br />:. .. .:.... <br />.. <br /> <br />......., ... ~~: <br /> <br />,...; <br />,I:,.. . <br />~ ... <br /> - <br />, ... <br />EITUIR <br />EMENT <br />::H <br />,.. <br />, .....,r, ~ .... <br />~ <br /> <br />:.:; <br />>" ~ <br /> <br />. <br /> , <br />. . ) <br />. <br /> '~• SAMPLEr <br />~.-. MEASUREMENT <br /> ;. <br />,.: <br />...,... <br />:. <br />.. <br /> <br /> <br />~ <br /> <br /> <br /> <br />. <br />~~~~~ <br /> . <br />E~E:111REMF$JT ,;..... <br />;.: r:. <br />:.... :<..:...,::..::: . <br />..:.:~:: . <br /> .. ... .:..::: .....:~ • r, .:,..::. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> ~REQ.UIftEMENT" <br />~ < ~?;" ':'Sx... <br /> SA PLE~ ~ ~ , <br /> MEASUREMENT <br />. :>:. .. '::. Yjyr' pp:.a:': ~::. .. <br /> ~ <br />NAME/TITLE PRINCIPA~EXECUTNE OFFICER 1 CERTIFY UNDEfl PEN11LT~Y G <br />AM FAMILpfl WI?N TFIE IN l!~~v~{rNAt rrAVE <br />PEflsoilAUr ExM11N <br />RytATYON SIMMITTED HEREIN <br />AND EA ED AND <br />SED ON TELEPHONE DATE <br /> <br />MY INQUIRY ~OF-TRO9E . : <br />WWVIDUUILL4"IMMEOIATELr RESPONSIELE FOR ~ <br />~ <br />_ <br />i?ICFIu r,,i M1'iIIIS <br />OETNNING THE INFDRMAT)11N <br />TflUEr A CUMTEE A D OM <br />;1 fiEL1EV~'TNE 4UBMITTED INFORMATION 19 <br />E. ! AM <br />AWARE THAT THERE ARE <br />~ ~ <br />/~~ <br />~~//~ q 9 <br />K <br />CIIVFI'r)IIRIP.fItaI .IVIaf1F7 C~E1-~ 410NIRC~PENALTI[S ftlR . <br />SyeMITT1NG FALSE INFORMATION IHCLUOINO <br />~ i <br />%K/" ~G~(1 $7Q-272 ~~ ~j ~:~ <br /> THE POSSIeIL1TY OF NE ANp I FRISONMENT. 9EE 18 U.S.C. ! <br />DD1 AND 33 EIDNATURE OF PRINdPA <br />E7tECUTNE <br /> U.9.C.. f 17[e. lAnrEFr urMr rMM .bemr MY Mr.'AIW FMMa ,p ro S IO,00D I <br />TYPED OR PRINTED .newnra:,wni+wirdrrw,r elbrwMn6mmA.rq 6Yra! OFRCER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />4VMMtN IS ANU [APLANA IIVN U. ANT VIULA IIUNS !)Ye/ereDC1~0//'ItrEt/IT6nr5 OBrI/ ' <br />~~IFLtAULt SULIUS L1MII :iA1VED PtiR- lOYFt,24Hit P~fLC1Y EYtYi-SEE.I.A..ie PO 1V,rUK ntdU1.KENENiS. ULL a <br />vKLA~t GKAB SAMFLY AtvALY5F5 Kk 4iUI REU IF VISIFiLE SHEErr IS Oaj SERYc D. .1k ikLY SAMPL1Ni. InSTRUCT I[;:~5-I .:..,., <br />am 3320-1 108.95) Previous editions mey be used. ~ IR tACE6 EPA FORM T40 HIGH MAY NOT BE SED.I PAGE OF <br />' OJSJ2/y610U1-1311 i <br />