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PARAMETER <br />0247) <br />(.1 Card Only) QUANTITY OR LOADING <br />(4643) (5441) <br />( Cord OM)) QUALITY OR CONCENTRATION <br />(18-45) (46-53) (54-6/) <br />No_ <br />" <br />61-6,(1 <br />4 q tau c.c v <br />Or <br />ANALYS/S <br />t 64 4,6 i <br />sA, 1 <br />t 6 <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVER AGE <br />MAXIMUM <br />UNITS <br />Dis. Hg <br />SAMPLE <br />M EASUREMENT <br />040001 <br />0.00005 <br />1 mg/1 <br />1/30 <br />, <br />PERMIT <br />REQUIREMENT <br />0.00006 <br />o.0co12 <br />alinity <br />SAMPLE <br />MEASUREMENT <br />210 <br />25 <br />1/90 <br />• <br />: <br />PERM IT <br />REQUIREMENT <br />SAMPLE <br />MEA�UREM <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />_ <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIRIEIAENT <br />NANE/riTLt PRINCIPAL EXECUTIVE OFFICER <br />1 CERT FY UNDER PENALTY Or LAW THAT I HAVE PERSONALLY EXAMINED <br />AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN Aro BASED <br />ON MY INOUIRY OF THOSE INIannoyALS IMMEDIATELY RESPONS BLE FOR <br />OBTAINING THE INFORMATION I BELIEVE THE SUBMITTED INFORMATION <br />IS TRUE ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG <br />NIFiCANT PENALTIES FOR SUBMITTING FALSE INFORMAT/oN, INCLUDING <br />THE POSSIBILITY OF FINE AND IMPRISONMENT SEE 19 VS E 1 .00, Atm <br />33 U SC 1 1 319 'Pentanes under throe Matures no" meted. fines Am to Slo,thm <br />and Ur mow/Ram onsoisonmen r of Arttrefn 6 months end I .tteir a <br />TELEPHONE <br />ATE <br />Robert A. Larson, Consultant <br />la <br />I „ic. ... <br />87 <br />i <br />1 <br />7 <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />a <br />30,..) <br />1 YPt0 OR PRINTED <br />AREA1 <br />CODE NUM 8 ER <br />TEAR <br />MO I <br />;/,0 ,,,r <br />HAMM <br />Toro de Plata, Inc. <br />AP.211/M4 PaO.s.DOX 8 5_ <br />81 <br />nma Rovenue-VirEiniue Hipe <br />L.QcAric14 sW Ourayi CO <br />COMMENT AM, EXPLANATION OF ANY VIOLATIONS / 44 k 144 N 4 fill ugfot Inirnt$ li.ry <br />015CMARCiE MONITONING REPUNI (V4KI <br />1246) •1; 19 <br />00-004Q550 <br />PERMIT NUMBER <br />FROM <br />YEAR 1 440 1 OA Y <br />j37 L 6 1_ <br />,10 114 '111 124 240 <br />MONITORING PERIQO <br />DISCHARGE NUHeEPI <br />YEAR 1 MO I OAT <br />T O L87 <br />.,/*/ ,:A:•1 f <br />NOTE; Read instructions before completing this form. <br />