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<br />Paperwork Reductio~~ Act ]~folrc~
<br />Public repuning hurdru is ~~ ti:iv =::: i~__t.en of information is estimated tr. .:u} f. ,m n range i~f 10 hour: as an
<br />average per rrsprmsz (o~ sort:c mino• facilities, to 110 hours ac a¢ a.eragz f,': rr,!nnsr for some fna~rr la:ilitiec,
<br />wuh a weighted average fur major .viJ minor F.,c.l!ac. ~'` 18 hours per Iz:ga,rre, inc!:tdmg time (or reviewing
<br />instructions, searching existing data sources, <<'-e~.: :a, mtainhtining t~t lh:t nzc.t:d, anJ compleli¢g and
<br />reviewing the collection of inforTr aon. $~,1~ co.--.:;.-I,•. rcgzadrn;; the b~: JBn r stimao..or any other aspect of
<br />this collection of infnrmation, IacluJing suggrcl.om ;itt naucinf~ this border, to Chief. Information Policy
<br />Branch, PM-223. U.S. Envirommrnt.+l Proteaio:: „gene}, 401 NI S"reet, ';,~".~ . ~g. -,, DC 20460; an.; to the
<br />Office of Inkrruratiun and Regulators' iffamy, Ottice of Management and lit !;;~. : s! ;r~tr~l,, ~C 20503
<br />J
<br />General Instruction
<br />I. If form has hezn partraA,• cemp~ete.. h}' preprinting, Disregard Imt~u9 -~n, J .k st entry of that information
<br /> already przpnnlzd. '
<br />7. Enter "Penruner .\~arna 1J-nn,•r~ .-is"rfreas (and facility n:unv,ucatiot ;f .-f:r. tJ," "Perrnrt N;/wrer," and
<br /> "Di,c:.hnree .tilunh,'-" c. hr~c iadic~ic; (A separme forn~, is requucd for ~.:h ti : :!ar: 1 '
<br />1. Enter ~a;cs heguimn~:m~ rnd•~, .'.,niru: rnk Yrriud"coves: u} t~•;-n t i J
<br />,. F.nlcr rndt "pnrnnrrr,'%' :I: stx:~ _.z.i ~ ~. wol! ,oring rcgc~rcmcnL .'~ porn 1.
<br />' Emcr ' ., .' 1J. ,.. ,. , n' • . ~d, , :uamcler unc!cr "',,. I
<br />', a::• :i:: i . peen: t
<br /> ~s uurm:;J •, 1; ~ 'r : t.:' ~' '. cometnc at eut;c i~ r
<br />.. :~. c:m~ is ,i; :a• -emert.
<br /> r„r ~ ~,:. ~~ ceran;~tc; obtainer: d,:. t ~ ~ ~ ,rrng Perio~", ::.1.., ,. ~ .. ~ ;:o:u:.~'I•. ~: ... ~ in,a
<br /> vtd icm mc.:,urcmcnls chl.u •.. -.n~ t&milurin,¢ f'~'r10,: ~ ~ - _ti f. .: r11! .L_tifk a,
<br /> rrgllii C'a'nl F. (:!"' ~:~-~J:,, ~. i31np!l' Inl.'a$Url':IL':II ~
<br />~ .:, I!' .. ... 7- h, a: er':,
<br /> .~fsam;:!c r._ ~.rrr_,r.,s c'• ~.:r ~.
<br />. ~•g r.tonitoringpcru~J umic; -
<br />.. r.nlc'r 'Perm.. R,•gmrrmr• L~i ~- ~ caramelerundcr',J~:,rl!r~ r , ..t :. _ ,..,~„r.l
<br /> -
<br />h. er ."~~ r emer nu.,, ~..~~_,~ c ntaasut~rtenh uunn; r ". ~ t .
<br />~ ..-.
<br />•. ~~ ,cr•~~ t .:, :;!~ ua (vtd'i:
<br /> minnuum or 7-day at crati~• as ~,•. r.rn, ude) permit requirement f;l •• r . .':;t': G
<br /><. Fmer '7•reow~nn' ,,, ".'~;rl.. ,;,^ .~•_,i ac ".1..urplz A•leosurnu•n;" ~.::_~~cl n .I ~ , . .., mi;~~-, ;.n~ L~15!'•.i: ut.~o
<br /> durng, monitoring penod r.n~.. as "^ernn. kequu•emenr" spec fir.. u. ~:, i, ,. ~ ."%r~ " `i: ~:'.,rtinaov.
<br /> monitoring. ' ; 7" for cur ~I:,~ ;~^r „eek. 'i ;q" for one da} per crot.;~ r .. .. .:..a.lcar ~. .
<br />9. Enter ".`'ample Type:. bmi: ua icerrfr,tieasvvenu•nP' L.u!ua[ •.ar.~:,i: h :,: Jar .~,on!ror,;g rc .. _ -
<br /> "Permit Requirrnren/," ;l.o.. EI'tef "(irnh" for indi~~idua. .;ample, '.. ro: .. ..- ,,;;r~x::.i,~.
<br /> continuous momtoring, ct:.)
<br />10. Where c~olations of pcrmi: regatrcmznts zre reported. attach ~ I: ric(c~i~h: •ar: . n, to !r, rib. ta~.,e ar . _ . r .
<br /> actions taken, and refcrcrne eacl; violation by date.
<br />I L If "no discharge" occurs during monitoinf penod. emer " .e: Urschorte' :cr: ass -oar. p ::cc o;'u.~ta ,:, !
<br />12. Enter ".\'ame?rrle gr Prinrip~d Crrcuh ve O~eer" with ".1Sgrrnrure ql f'rn cl. s 6t.: i.uvr •)/f<:•r r.•~- c.._c
<br /> Agent," 'Telephone h'umbvr," anc "Dote" ai bottom of form.
<br />13. Mail signed Report to O(fice(s; b} date(s) specified in permit Retain copy fo: y w rc. xus.
<br />14. More detailed instructions for use of this Discharge Alonnurin,g Hrpur; 9't '.(~ f ,rrt. r:!:;, ~~e o;HtiacJ iio~ ~;-.-_~s
<br /> specified in permit.
<br /> Legal Notice
<br />This report is required by law (33 U.SC. 1318; 4C C.F.R. 125.27). F:.ilure r r:pr or f.: ~.:rz to re;•ort t:c.: ~ ~", .
<br />rrsuh ir. civi{ penalties not to exceed SIG,tA1G per day of violation; or in cnmi~r j nr P~.tirs . u: '.., er.r:~;l! 5-L..1•=' _'~ ~ •
<br />nt violation, or by imprisonment for no. more than one year, or by bath.
<br />EPA Form 3320-1 (Rev. 08-9~
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