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<br />---- - Pa~lae.*work Redlic~io~~ Acs Notice-- - --- ---
<br />'ublic re}ror in}, burden Fo 'I-a coilec ion of information is estimated hi vary From a range of 10 hours as .ur
<br />.vemge per resf~rase `o- so ~~ a nr.nor `acilities, to 1 10 hours as an average per response for some rmjor facilities,
<br />with e wcgbtei tve~;a fc ~ z`ar s_rc' minor facilities of 18 hcur, per ,tease, including timr, for reviewing
<br />n.arucrions, sua-ching ezis' art rata sources, gathering rzcf marn'c~inin~ :rs civ~ needed, and .:ompletiog tmd
<br />-eviewing th:; c,'lec'ion of n(ometinn. Send comments rager(i-k ~e ..ds. rstimate or :my other aspect of
<br />'his cHlle_tinn o~ informa6nn, including suggesiioas for reduc:r; ti: ' ;rde•, to C'iief, ;nfcrmation Policy
<br />' '3ranch, FM 22', U.S. Environmental Protection Agency, 401 :v' ~trrxt, '';.r 4Vashington, DC 20460; and to the
<br />office of lofur¢: lie: and R.gulewry Affa-."s, Office of Managa•re~:[ ~d '~dgut, `Nashingtor, DC 20503. -
<br />P~eral Instr~..::aia)~ s
<br />1. 1f form has been par[iai'y completed by preprinting, disregard instr~~~. rions directed at entry of that information
<br />already preprinted.
<br />2. Enter "Permitrec ,1'omc!llmling t'ddress (and facility nameAoeaCnn, .f diBerenl)." "Perini( Number," and
<br />"Discharge.".'umber" where indicate?. (A separ~[e fo.~rt is regwred for inch rLscharge.)
<br />3. Enter dales beginning and ending 'Slfonitoring Period" covered by form tirhere rndieated.
<br />4. Enter eac't "; ammeter" as stecifed in monitoring requiremer[s o(per ~r.t.
<br />5. =near "Samp!e,lieosu-eo;eur" rata nor ei'ch+~arrmeter under "Quantir ` Ord "Quafinr" ~n onits specified in penni'.
<br />'Areng; " i; no~-ma'!y r'f'^'_~ic a~.~crage (gco.r.etric average fcr ;;ccl _,~' pa~~mcie,s) of as sample measurentent_s
<br />;Hr each pac,mCCr a~tr red du~rg ".lloritorin~ Pennd"; ".tin: ~mr1N c rc~ ".:'inrrau.;:" arc vernally caVC:ne hgh
<br />Ind Im' m_surernens o'.t ~i zed during ".llor,irorurg Period" (Nr-, is :~unieipals c,ilh secondaq Deat n.n!
<br />require-c t;: E: tnr 30-t r. ^~•czyc of sample measurements c td.:r " ,. _; age," utd enter maximum 7-da} atrrage
<br />of sample mcaa.'ement= oi~'ained daring monitoring period enter ".4fc. urrtm.
<br />G. Enrcr "P~ruri' Requirenrrni` 'or eac'• parame[cr under "Quanfh%' and ~'LoIR;/' as sr.xi'icd in permit.
<br />'. Unde~ "~'o ,s" rmcr -~!rb_r of samn'e measurmcnis durit; moc~~ ~~+.;; -?:icd that ercced maxir~un. (a:tc/ar
<br />-'i "ir;w: c 7-rL•+}' ^•.rr.ge as ?p?rcpria!c) permit rcyuiremen! rot ear ~ ;zr2r'e:e". Irnone, enter "0'.
<br />E. Enter "1 ieq;:encv of F. ailsis" bo'^ as ".Sample '.Irnmrmes!" (ac''; :rcn ucnc}' of sn mpli tg and anal; sis used
<br />durim .*•,or :oring pcci; au: as 'Per:nir Requireumnr" s?ccified -- :r-df. (c. g., Enter "Cans," fnr continuous
<br />monitoring, "//?" for o:x c c}• per s:xk, "1/30" for one day peg rnonUr, t r90" ,'or one coy per r carter, etc )
<br />9. En!cr ".~ampre Ttpe" ~C~' as "Sample ,19easuremenl" (actual samnlr ';oe us:d during mcnitoring period) ate'. as
<br />'Pen,rit ~4erurrrneut," (c.g., ='r ter "Groh" for individual sample, ~.'.af/C"' for 2d-hoar composite, ";t'rF" nor
<br />con.iuueus monitoring, etc.)
<br />0. Where ` olt,lions of pe r.' •equirements are re?orted, altaci a brie" :::nlzrztion ro describe cause and cortccCve
<br />actions taken, and referctce each t~olaiion by date.
<br />11. 1f "no discharge" occurs during monitoring period, enter "No Discham~~" across form in place of data en[r}.
<br />l2. L-NCt ":~'orrv^/1"lr ajP.ircinal /:xecative Officer" with ".Si,,nature -,,/'P.incipa! Pxenrirve Officer njAa(horized
<br />.9g en r," "Te.'epl.ene .4'urrbc,-," and "Dale" at bottom of form.
<br />l3. Mail signed Re;:ort to O~cc(s) by date(s) specified in pcmtit. '2etain copy for yotu records.
<br />14. Marc do taiP d irstr~eticns 'or use cf this Discharge.4fonirorinq Repo._. (D,..R) form may be cbtained from Otlice(s)
<br />spxified in Hermit.
<br />Legal Notice
<br />T` is report is regvifed by law (~3 U.S.C. 1318; 40 C.F.R. 125.27;. Fxi'r: [o re^ort or failure In report truthfully can
<br />-_:ult in cit i'. penll[ies not to exceed S10,000 per day of violation; or it c ~ ~~,~ ra' ?enal[ias no[ to exceed x25,000 per day
<br />o~` violation, Hr by imprisonment nor not mare than cne year, or by both.
<br />LI?A Form 3320-1 (F.ev. OS-S S)
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