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Pl JIMII TEE NAMr +<E65/InJuJe <br />l aul~•ee~~r'I ~. I rnU <br />NAME _ e E rLCJ AL ~Q__. 4+~LLGLA ~ I.9 +.J. - - - <br />ADDRESS 1 3 L~Q ~,(~'[u ~.I(L F~ _ _ ~ ~.-- - - - <br />FACILITY _ _ _ __ _ _ __ _ _ _ _ _ _ _~ <br />LOCATION__^______ ___~_~_ <br />A TT'." TIRYIIT S^pYENS(7t1_ ~IE'$Ini; iiT <br />NATIONAL ~~ I .U ..1 Vai_ it IA ~~ ~ :. S~ TIE allnYUm/ <br />UIJLN Qn1l Uirlnu ii[rVnl1/~~n/ <br />l1- (!L!9) <br />O PERMIT NUMBER p16CHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />114111 111-13/ (N-1J/ 1:6771 /1879/ p43U <br />P - FINAL ~ <br />STORffNATF.R DISCH.IRGP. <br />nIROR r.RTss <br />NOTE: Read instructions before completing thls loan. <br /> (3 Cord On/vl QUANTITY OR LOADING /Card Only/ pUAL1TY OR CONCENTRATION <br />PARAMETER /s6331 IJ1~611 (3877/ llS77) IJFEI/ NO. <br />E% FREOUE NCY <br />GF SAMPLE <br />TYDE <br />~J1i1J AVERAGE MA%IMUM UNITS MINIMUM AVERAGE MA%IMUM UM1'ITS B <br />AMLM14 <br /> Ih7~51 / /b9 MI <br />)IL +1 tIC (.9EA56 SAMPLE TitT~'-i v'F#### v+vr## +`•s•`-v`rv~ <br /> MEASURE :'EI`:T <br />ISDAL <br />4065 1 D U PEi,MIT ##``-.Yf?? Y <br />V 55=1 ##:#4# ###'k## +##### .e LICE/ I50AL <br />FFT,UERT GROSS V4LIl F: REQUIREMENT 9S h NO=L1 [;~eRlrT <br /> <br /> BAIAPLE <br /> MEA6UREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEA6UREMENI <br /> PERMIT <br /> REQUIREMENT <br /> SPMPLE <br /> 1AEA6UHEMENi <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> AIEASUREMENi <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMErT <br /> PERMIT <br /> REQUIREMENT <br />N ALt EiTR LE PRINCIPAL E%ECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE P <br />AND AM FAMILIAR W11M THE INFORMATION SUBMITT ERSONALLY E%AMINED <br />ED H <br />REIN <br />rJD <br />AS IEIEPHONE DATE <br /> <br />Drian P <br />Dunfee ; A <br />E <br />ED <br />B <br />ON MV INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RE6PONS16LE FOR <br />. OBTAINIIJG THE IrJFORMATION. I BELIEVE THE 6UBMIi1ED INFORMATION <br />Mana er <br />9 IB TRUE. AOCURATE AND COMPLETE. I AM AWARE THAT THERE ARE 61G <br /> <br />NIFICANT PENALTIES FOR SIJBMIIT ING FAISE INFORMATION, INCLUDING 6OL 774-5253 90 07 25 <br />Environmental Studies THE POS6IBILITY OF FINE PND IMPRISONMENT SEE 1B V6G 1 1001 AND <br />3] <br />S <br />1719 <br />/ <br />C SIGNATURE OF PRINCIPAL E7( UTIVE <br /> <br />TYPED OR PRUJTED . <br />. /Prna <br />U <br />. 1 <br />urt unJrr rhrsr vamla may inJuJr lnn uP m 1/O.WD <br />onJOrmanmum lmvmonmrm o/b.,.rrnemomesnnd Dy.na.l <br />OFFICER OR AUTHORIZED AGENT PREP <br />NUMBER <br />YEAR <br />MO <br />DAr <br /> EpD <br />AND E%PLAN ATION OFANY VIOLATIONS IFeferenre a!l oeaa'hmentr heir/ <br />IF' NO DZSCi(ARGc OCCt1P,S RF..PORT °1f0 DISCIIARGF.°. OTL A"•1(7 GRP.ASE~ SZ$ FOOT:IOYB f/• <br />EPA Form 3320-I IRBV. 9A81 Prwv/nlJS wrlirinns may An Nead. (REPLACES EPA FORM T~~O WHICH MAY NOT BE U6Ep.1 PAGE OF <br />CC257/1COS(9-17U4 2 7_ <br />