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PERMI77EE NAMElADDRESS /IM,birlGyl/r/Lauen Ifol~mmf <br />NAME 4'(,°KL.] C,~r inC f.jri FrUK%,TIUN <br />ADDRESSp+ U r1I i x ii t, <br />~ I.nAIi+ CIS tilb2b <br />FACILITY (.Yl-nlrS CMPIRE GUKYUKATIUN <br />LocAiwray KA1 J (;(j X162}:. .. <br />IiTTi~ MICHArL i:. LUI;i..~w. GFtrF1iA1.~ NGp ~ . <br />FoMMrm 1BA/1pproved.p <br />~~LIL~ ~r' IrTY.:. ~C! ~gpPB vile2p4es0531~98 <br />SUblt Ni. 1~,4~ <br />F - FINAL <br />w,lh~K <br />#c~a NU UISLHAnLL +'t'a <br />NOTE: Rnd Inewetioro be}on completlnp this form. <br />PARAMETER (3~Grd Only) O ~~Y <br />n !I Grd On/yl QUANTITY OR CONCENTRATION NO, FREDUENCr SAMPLE <br />l3Z-371 146-53I / ~ h ' ' ~ % (38-I51 !46-53 5461/ EX OF <br />TYPE <br /> AVERAGE MAXIM ~ /I75 MINIMUM AVERAGE MAXIMUM UNITS (a3~631 iVdiLLY~s <br />!6468) I6e-7O1 <br />LLIUSs Tt,TAL SAMPLE ~,t#P%rM r#iFp## ##1-~IiK 1 ) <br />/ <br />rl.i~UL VLU MEASUREMENT ~ ~ GJ O 2 21if <br />c~v5 I o ~ .. ..: 4il#I:III>~apl .:.: ..ItIF~4-!+6i'* i ## '" :~'> <br />~ "'i' <br />~~ ,. ;~~„ <br />~'Udl' <br />~)Ff'itJNil, <br />Ti~LY _( <br />:,.,ts <br /> REniliyEivIENT. :::, . <br />, .: <br /> <br /> ~~ SAMPLE <br /> MEASUREMENT ' <br />.. <br /> .:~~AEAMPi..~..`i <br />....: <br />. .. ~ ~~.. ~ <br />,: ~. ~ <br />~ ~:. ;: <br />.::....:•~i:~ <br /> . ;:~: <br />+:. <br />: .. <br /> .SAMPLE <br /> MEASUREMENT <br />' .,::'.PF6y11T:: .. <br />,. .. <br /> <br />.. <br /> .: QI=CSUIREME.NF+ . ~ '.~ ~ !.!: <br /> SAMPLE <br />'.. MEASUREMENT <br /> <br />. q~nut~EMEi11T <br /> SAMPLE' f <br />~.., MEASUREMENT <br /> ..:';~. ~. MIS:.; ~ : :.. ~ ~ ~ ~ ~ ~ <br /> <br />aEgrlil3~~lNk` <br />: ..: . ... <br /> SAMPLE, <br /> MEASUREMENT <br /> <br /> 'R~bUI~EMF,~;I.~ <br />,.,.. ... <br />'.. ~'Ar.. ~ .. <br /> SA1v1Pl£ ' - <br /> MEASUREMENT " <br />_ <br /> ~ ... .. <br /> .,. . <br /> <br /> <br />~..• :. <br />....:: <br /> <br />:6. .. . '... .:.::.....: <br /> <br /> <br />..i:. <br /> <br />-.: <br /> <br />~ <br />NAMESTITLE PRINCIPA4 EXECUTIVE OFFICER <br />' I CERTI <br />AIAFA FY UNDER vENUTr Or LAw THAT I HAVE Pmso <br />I:I1LIAq WITtl THE INFORMATION SUBMITTED H NALLr E%AMINED'AND <br />ERDN <br />AND BASED ON TELEPHONE DATE <br />' <br />RIC}1@1'ii C?fills ; <br />MV INQUIRY OF THOSE INDINDUAlS IMMEDIATELY RESPONSIBLE FOP <br />O0BBTAMING tFE INFORMATIDN, I BELIEVE THE SUBMITTED INFORMATION IS <br />7 <br />UE <br />ACCUMTE <br />AND COMRETE <br />RE THAT <br />I <br />M <br />HERE <br />W ~~ <br />~ <br />~~ <br />•_ l <br />fIV IYUPI ER?Il T;a l' MBna <br />er <br />Cr- 8 <br />, <br />. <br />. <br />,A <br />} A <br />A <br />ARE <br />T <br />310NIFILANT PENAITIE4 iOR e1MM1TTING FALSE INFORMATION <br />INCLUDING <br />970~H7O-Ill! <br />~~ <br />Y~ <br />9 <br />~ <br />. , <br />THE <br />SSIBI <br />TY OF ~ ~ <br /> D <br />LI <br />RNE AND IM SONMENT. SEE 18 U.S.G. 1 1001 AND 34 610N RE OF INCIPAL EXECUTIVE <br /> U.9.C. 1 1370. /Awls. u.er drw mrun. mry Y,eA.di /n.. w ro lIO,DOO <br />TYPED OR PRINTED r14 rnrr:m.n lnorbmrr~nr or e.n.•.. enladr, rW6rA.'AI OFFICER OR Al7fF10RIZED AOEFR CODE NUMBER YEAR MO DAY <br />'GVMM[N IS ANU tAYLANAl1ON Vf•ANT VIUCAIIUNS //Te/6/60Ce M/IffaChmenfs ha/e/ ~ ' <br />r"~.. LIMII dPYLIFS TLI L:LMtsi,VcL FLLiI Fr:UM JU1~ 012 r: UL4. u[L %~bi(tASe ur{Ab .iAi'PLc AiIALY$TS kfGJIKc~~ it <br />vi~,;L~ SNttN [~'U~SEriVLU. UKiKLY SA:7PCItvG irv$TKUCT[UN$-I.G.b, PG x. <br />EPA Form 3920-T 108.951 Previous editions mey a used. IREPIACES EPA FORM T~0 M'FfICN MAY NOT BE USED.) J ~ ~ j ~ / 9 ~ 100 I' 131 1 PAGE I OF <br />