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Fnrtd+} tvan+ -;I r.tau,.n if thOrrrn[ <br />ty,kt4 E Toro de _P1ata Inc. <br />ADDREae P.O. Box 8 � <br />FActLtu Pgienue -V .r nws Ph : ne <br />LOCATI : C _ <br />PARAMETER <br />02-37) <br />Oil & Grease <br />Robert A. Larson <br />TYPED OR PRINTED <br />SAMPLE <br />MEASUREMENT 0.64 <br />PERMIT <br />REQUIREMENT 3 <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREM EN t <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />NAME /TITLE PR(NCJPAL EXECUTIVE OFFICER <br />FROM <br />Card Only) QUANTITY OR LOADING <br />(46 -S3) 104 -611 <br />AVERAGE MAXIMUM <br />REQU NOTE: O tfa11 001 is inacce <br />SAMPLE <br />MEASUREMENT <br />PERM IT <br />AVOW REM ER'r <br />SAMPLE <br />MEASUREMENT <br />PL'RIAIT <br />REQUIREMENT <br />SAMPLE <br />MEASURFMENT <br />PERMIT <br />REQU t IREM ENT <br />::OMa4Errr ANU EXPLANATDDN OF ANY VIOLATIONS tRPh -r,nr: 011 ,,uU.Anu•nt,a herr) <br />NA IUNAL POLLUTANT DISCHARGE ELIMINATION SYSTEM t 4 P1)3= <br />O1$CHARGE MONITORING REPORT (1)■1R0 <br />(s 16) f 17-19) <br />;0- 0040550 [ <br />PERMIT NUMBER Ti +SCH ARGE NUM dLR <br />MONITORING PERHJQ <br />YEAR Mt? F I YEAR I M.„1 r/4 r <br />- 86 12 1 1 To 86 ! 12 31 <br />t:r. 1h t2: 2', ?N•1.4 114.2 "t t) _4 41,41)) <br />UNITS <br />CFS <br />1 Card Only) <br />(!R-JS ) <br />MINIMUM <br />r r( ,MIrl UNGER PENALTY 1 ■F LAW THAT 1 HAVE PERSONALLY EXAMINED <br />AND AM FAMILIAR WITH THE INFORMATION SU:ERMITTED HEREIN ANC. RASED <br />ON MY INQUIRY pF rHo$E INDIVU7IIALS }MMEDIATELY RE$PONS:RL FOR <br />C'E:TA!NlNC. THE IN ORMAIION I 41Et WYE THE :URMIT I FO INFORMATION <br />1''. TRUE ACCURATE ANT) r.JMIL4 E 1 AM AWARE THAT THERE ARE SIG <br />r+IFICAN, PENALTIES FOR SUOMtTTtNG FA. SE i 4+r;1RMATJQN ?NCI UDtr10- <br />THE PUSSIII+I ITV OF FINE AND IMPRISONMENT SEE IR L4SC 4 }WI AND <br />7 =. U'� t' 4 I .1 'P- +rater, 4 u,ulrr thrw etutu J +A MAY inchuir I ., . un r., f J4' 14x0 <br />and .0 rno«nlum rnWnimn 'Ilene,4 Artu.r.n A month! and 5 r.•nr. 0 <br />7.25 <br />6.50 <br />QUALITY 014 CONC('NFRAT)ON <br />( +b -a I I (54 -6!) <br />AVERAGE <br />7.89 <br />Bible due t• the pond b ink; frozen. <br />NOTE: Read instructions before comptettng this form. <br />MAXIMUM <br />8.0? <br />9.0 <br />0 <br />UN ITS <br />TELEPHONE <br />t.. <br />.4AS• <br />I f}If.i+ <br />/3O }: isua3 <br />SIGNATURE OF PRINCIPAL EXECUTIVE 303 3257 <br />OFFICER OR AU11r>N 17EG AGENT � NUMBER 1 l AR <br />!f r,rtl: i tl(7 rCR c'Q <br />u,Vb' Am, 2000.0 <br />SAMPLE <br />TYPE <br />Inrt. <br />Inst. <br />