|
Paperwork Reduction Act Notice
<br />Plihii. r,~rv.r;:np nUnirn ~nr 1h1, w~ b'.'linn Of infurn-u;;lon i+ rNlrnatul iJ C.iti 'r,-~7 n ran Vr of If/ hnUr~ a5 iln i
<br />average nL`r rrcru,n er, far come minor fgalities, to 110 hours as nn uveraee per resnoose for some tnainr facilities. I
<br />I with a weighlzd average for major and Honor tacdrlles of IS hours per responcz, mcludmg hme fur revlzwrog
<br />~ instruction., crarrhinv existing dabr soun;ev, exthering and mxinL•rining the data needed, and completing and
<br />it revirwing the collection of mformahun. Saud comments regarding the burden z+4 mute or any other aspect of '
<br />[his collection of information, including suggestions fir red~!cing this b~!rdrn, to Chief, lnfurm_"dur. Policy
<br />Branch, PM-223, U.S. Environmental Prota ion Agency, 401 M Strut, S\1' Washington, DC 20460; and to thz ~
<br />' Office of Information and Regulatory Affairs, Uftice of Management and Budget, Washington, DC 20503.
<br />I
<br />I - - - - -- - - -' - --
<br />General Instructions
<br />1. If fern has been partially completed by preprin!ing, disregard instructions directed a! en!:, of that ~r,f~,,,,~tinn
<br />already preprinleal.
<br />2. Bnter 'Permittee Nnme~iNai(igq Address (and facility ttame/IoCalion. if di6erenq," "Parini! Nmnher," and
<br />"Discharge Number" where indicateA. (A separate form is required for each discharge.)
<br />i Erln dales txgiuoing and ending 'i1•fomtoring Period" wyered by form where indicated.
<br />4. Eulcl ul~h "('urmnrirr" as spctiificd in monitoring raµurcmenls of permit.
<br />5. Enter "::ample ,t:rmuranlrn(' data for each paramdcr under "Quantity" and "('.mhry" in units spceacd m pemtil.
<br />".1 veraka" is nonmtlly arrthmcuc aycmge (geometric average fur b~derial parz:nacrs) of all sample Ir:asurements
<br />for each paranuti~r ebtaincd during "llunu.u~o~c Prriud'; ",lfuri+,:.,.,," and "1;u;iorom" are nonn;ln .;;: ante high
<br />and low measurcluenls obtained dunng "t!nnironng Period" (Hole to municipals with sccoccct~; L; garment
<br />avers ~c w .u; ~ :aslrreuteuu wlu; ~ " ...~.;c.' ~I~d enter ma„~,., ~ ' ., avers .,
<br />rcquiremem: Enter ~~`-d,15 b ~ t ~ g
<br />of sample mcasurcments obtained during nlOw;oring period under ",'.:r,ri,.,~urr')
<br />6. Enter "Prrmn .R^:;rrrrrrar.!" far each parameter under "rZv~ntily' nnr+ "llualih-' -c memfied in peon!!.
<br />.. U`ndcr '.'do Es n(a nutnbzr cf s. ^.p!:: m: urn::.. __. ag monitoring prrie%' 'h~, _,:ceed iMximum (god/pr
<br />minimum or 7-dad average as appropriate) permit rcr)uirc ~•'^ii fur each paramclc: '; -(`sic, enter "0'r
<br />I l Y facto„ I ~ .,i -,..;.p::cg ,. ,_.....
<br />8. Eulcr "Frrt vencv u ~:inui~a,a" uuiil 15 '7;um .e S;cu.,.,,~;m;;:' ...I f: c: ucn;r ,. ;^•, °:::. ar"at~•~• "~;r
<br />during monitoring perod) and as "Perm! Rrgv,rena'nt" spcaflzd in permit. (e. g., Enter 'C'ant," far continuous
<br />ili0il11Urlnr„ "/ i° fGr GiiC d.i'i p,.r r "/ ~~° fcr one dap ps ., _-~.`, ..! .`,+;" for mtc da, pn, C;'1 ~~:'r, etc 1
<br />9. Enter ".Sample 7:vpc" both as "J'nmple ,tlencurrmen!" (actual sampic type ux:d during nwuiioring pel~o~, Wld as
<br />"Permit Requirement," (C.g., Enter "Utah" for individual sample, "_'-!I!("' for ?3-hour composite, ".~ A° for
<br />conlinuouS menllOling, etc.)
<br />I0. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corective
<br />actiotu taken, and reference each violation by date.
<br />11. U "no discharge" occurs during monitoring period, enter "No Discharge" across Conn in place of data entry.
<br />12. Enter "Name/Pille ojPrincipa! Executive Officer" with "Signature ojPrincipn( Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Dale" a[ bottom of form.
<br />l3. Mail signed Report to OB-ice(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afonitoring Report (DMR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 13]8; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
<br />
|