Laserfiche WebLink
PERMITTEE NAME/ADDRESS pll[A16FrWryNr./c«•++ApD+~wm9 <br />NAME ;,Yr'~~u7 t,41'1R~ CUriF•ur<HTll;ly <br />ADORES&F~ -1~ ,i 1]X bu <br />CkA[u co a16Za <br />FACarrvCYPr<i,5 EMPIRE Ct7;if'uhA{SCIN <br />LOCATIOI~~A 1 v <br />GLi blrlGl, <br />aTlh MICrInEt s~_ I;1LIlr:~n. I:rtvFltal s!I.< <br />Form Approved. <br />J • 11~ +++`~ / rI H ~ ri Li I~ h h i OMB No. 20180-0004 <br />Ap~o~+~l ~:p7es OS-r31-98 <br />~J..K Ivar 1 ~++ i <br />F - FINAt <br />MINOR <br />~#+M UISCHAkGE ~FU'f <br />:~'NGf eed Inetruetlone before tiny this form. <br /> <br />PARAMETER (3 Grd On! 1 nUANTfTY OR LO G ; <br />v ,.. <br />Id onryl p4AN717Y OR CON ~ ION <br />NO• <br />FrhouENCY <br />SAMPLE <br /> /46531 15¢511' I38d51 /4653 I5L61 OF <br />l31-371 EX A <br />ALYSIS TYPE <br /> AVERAGE MAXIMUM , U111TS~ MINIMUM AVERAGE MAXIMUM UNITS maem N <br /> - I5b6B/ I5&l0~ <br />~;,u ~ 7-0AY SAMPLE .. <br />~ <br />••6 <br />*##+ri1r <br />jq <br />i.u LicG. C MEASUREMENT .~ <br />~wlv I G U <br />:. . <br />$M..~ <br />nui .u ';.;i <br /> <br /> <br />;.:v . <br /> <br />~~`-.'~,,`,'.. <br />... <br /> <br />, L.:. ,~:## `.' <br />~~I~. <br /> <br />a <br /> <br />Q5 :: <br /> <br />tT;'.E! <br /> <br />n aT: <br /> ;.; , ,. <br />~ <br />h f'~`#«{v# :... <br />i#ppaal#•f ~ 7##0~F# :i <br /> MEASUREMENT , <br />~ , <br />'3. . <br />N!V 71 <br />~ <br />E) <br />f <br /> <br />- .,. .. .... <br /> <br />,. .. <br />~:. <br /> <br />. <br />::. <br /> <br /> <br />.. <br />- .R <br />Q <br />.L.,. <br />id.~ ..~: .. ~ r:':~ ~ <br />•r' .F•r .y <br />. <br />i •. <br /> <br />~ <br />1 l.L I:,S. i..i At SAMPLE ~ t:b '•ti';<•;•#M.~. . <br />u ~ N c N„~ J MEASUREMENT - <br /> K:. <br /> <br />... <br />.: <br />; <br />'~ <br /> <br />' <br />.v ,.:.,... ~~. :s.... ... .~. <br />~IL AIYJ uritA~E ~SA PLE #ti•#F1F+(r, is ##*A>t+6 t;••s#k t. #####+F lY <br />-Nt..;'v tJ(i k_G},AY ME~'M MEASUREMENT <br />0~.., 1 d 0• ~ Il"~, '. <br />;, <br />i~ >'. ~11~i4#,~Ff?~:` .f~fif±lk?k#;+0+ as ~#'t~#o '' _:;"~ii+i#rOF#~':... .:~j,`. :';';+,: '::: 3~ITINt itlifi <br />T - <br />} . <br />nu <br />ItE IRE}II~NT '" +~ :' <br />U N . <br />. ~: Mi'# .. <br />~ <br />'. <br />~L,.n. I.. ~UHllU1T ~yrt ~..sAMPLE' ~ U3 +ri•y•<ffi• #k{`{+MN <br />~ ##O?P#+b <br />hhu IKEA I MINT PLdNT MEASUREMENT ~~ . <br />,;: ,;~.+ l U U ~''PF~3MkT:': .41Z'"'.: <br />k~t;'; ~l'!.T <br />:' <br />k: ,VI~#+ittit8 :~?I(~!?~iy~klT'. <br />: .::MO:$~71t:~!:: <br />':: *# <br />tf~LY <br />t'aS(At+( <br />F Lut:vT „6~~55 J U B~11kEW1ENT, <br />..: , <br />: <br />', k ; <br />. <br />:; <br />: t ':.: ;:." . <br />..... ~•'. . <br />. <br />..., ~I## <br />~h1Lirtl`ItF TOTAL ~° SA~PLE' ,~+A4'~## -.:##4#+G/# ~ ~ ~ ~lyl+p+)#i+ dtk~+lpr*#. Iy <br />,t~iuLAL MEASUREMENt <br />>uuc~ 1 U U >:.:PERM17":: `<.' ; ~##11~~[Ip.,..:. <br />~ .'';?~!-'~t~~t'i! Wig '~~' ~X~+kal~# +ra1k~+S# i7e~~::' ~~+1jY tf+t[~ <br />-rr LUt/vT :iKii~S. VALVE ..,t~E.QUjjiEMEN'~ ;, :..,:.~ ."•.~':="..: >;t+t4 .~",.~~.~ ~ ~y.. ~~MA~X 'hG/L ~ . <br /> .SAMPLE <br /> MEASUREMENT <br /> ,.:.: .. <br /> 9~yulp~M~J~+k< <br /> „: <br />~ .:. ... <br />NAMERITLE PRINCIPAL EXECUTNE OFFICER 1 CERTI <br />AM fA FY VNDER PENAITr DFF,, LL <br />MILIAFpR V/ITIF 1RE INFQ1 AAWW THAT I HAVE PERSONALLY EXAMIN <br />11XIIT1 <br />MITTfD H EIN <br />AND BA <br />N SLI ED AND <br />SED ON TELEPHONE DATE <br /> MY INOUIIIY OF <br />' THOSE IN 9 <br />B <br />; <br />D~VIOlIAyS"~NIMEDIATELK RESPON98 LE <br />FOR <br />~• <br />~~ICflard t. I~~$ <br />T . <br />OBTAINING ~R1E1 F011MATQ(~ <br />ACCi <br />7E <br />N <br />R <br />T <br />I/E -+BECfv 7NE SVe l INFORMA <br />T <br />T <br />f ~' ~ <br />TION IS J <br />~ 7!~ <br /> <br />~ <br />1"VIY~~!11nP <br />T]tR{ A4ana <br />er 1 <br />A <br />A <br />p CoM <br />. <br />A <br />SIONIHCANT PENµTIE4 FOft~gg M7 AWME <br />NA <br />THE <br />ITANG FKSE INFORMATION <br />INC RE :ARE <br />WDING % <br />A <br />~ <br />37O'C7O-Li ~w <br />iO <br />XS ~ <br />O' <br />_ <br />. <br />y T{IQ POSSIeIUTY OF FINE AN[ <br />1 . <br />NMFNf <br />~ <br />EE 1 <br />M <br />V <br />S <br />C <br /> ~. . <br />SO <br />S <br />8 <br />. <br />. <br />. ! 1001 AND 33 BION <br />E OF PRINCIPAL EXE <br />UTNE <br />7 <br /> <br />TYPED OR PRINTED u.S.C, l t31s. lA+Wdr•Y~ . rMr mNN•.mFr bcMd• /n•s w~ro i+O,aOV <br />uK er n <br />i <br />b <br />l <br />lM <br />e ~ <br />G <br />A <br />CER AREA <br />NUMBER <br />YE <br />R <br />MO <br />D <br />Y <br /> lv <br />mlm <br />+lpr <br />rpMfrrf <br />bnrrn <br />mwN• rN E veal OFFI <br />OR AIJTHORI2ED AGENT CppE A A <br />Vvmmcn l o nnv cwr<n nn l lure yr nnl vlvLn IIVnA InelerYnce N/ 4+ISCnmenR ne/9/ <br />:. /c z. uKtASc likAd ~AHPLL "A>"~ALY~IS kEGUIRtU IF VISIBLE ,iHtEiJ I:i D$'SEkVEU. lf' NL (:HL~rti!•i: wad uScur +••.r'urci <br />~Li 7: L, CHLUitINt: TREATMLt~i UKTRLY SAMPLING IhSTkUITiU~4S-I.C•3/ Pu ,(• r: -tNL~T I7GhLUcIrT yi~;pLE. _I r. ~t;rt <br />orm 33 - -951 Previous edltiohe iney be used. (REPLACES EPA FORM T-AD `A"~ICN MAY NOT BE USED.) PAGE OF <br />" JU~ol/Yb1UU1~1311 T <br />