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Paper~~vork Deduction Act Notice
<br />Puhlic reporting burden for [his col!e=tion of information is estimated. to vary fcorr a rungz elf 10 hours as an
<br />e~erege per responrs fer some minor facilites, [0 110 hours as an average per -espo¢ee :or sorrc m~ejor =arlities,
<br />with a welghtad aeerafe Fo: majo- and rr nor facilities of 18 hours per :espo¢re, in_h ding time for review~g
<br />ins:ructio¢:;, sean:hing ezisling data sources, _+n'hering and maintaiaing Lhe data eEx~rrl, anJ cot-iplrticg aad
<br />reviewing tha colla:ction of information. SenC comments regarding ['le burden es~irvrle or any over ripe,:: of,
<br />this c, Ilec~.:'ca of information, inclining supbes'invs for reducing [his 6u'den, 'c "'lief, Irfor¢tatioa Polic}'
<br />Brunch, PD;1-223, U.S. Emiroamentsi ?rc .~ctior. Agency, d0I Ivf Street, SW 1Vashin~r_n, DC 204E 0; tad to tha
<br />Oftice of Ir:forma[ivn and Regulatory A". ors, O"^~~vc of Vanagemant and Budge[, Wasb~ngton, DC 28503.
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<br />Gc'ner~il Instructions
<br />~., If form has bxn partially comb e!e% Ly ;reprinting, disregard instructions eire=[w,.l at :r ry of that inFormstio]
<br /> aUeady prepruated.
<br />3. Eoler 'Rermitlee A'onre44oilu;? :~ci- !-ess (~•nd facility name/location, if diliercnl)," "'ermrt iJumber," and
<br /> "Gsclrarge.\'mabei' tvitrre indicated ~ A svpanle Corm is rcouired:orcach discia~ga.)
<br />3. Er cr dat_s bcg!aning and ending "A.h:: ,ltoring Rennd" coverer. b, form t~'iere indi:^ied.
<br />4. Ex cr ~ICh "Pm•mneter" as specified it aon tc~rg requirements of pernit.
<br />_ Fn'cr ".L•dnple ''ecs;~re+^erP' iat^ ''" •~ch nnrnmctcr under "Qoan!i!y" .,rlrt "Qunhr•" in urns S.CCii'inJ in permit.
<br />~
<br /> °fl^crorc° i5 nGnnf''~ a iil`mC. ^ .:
<br />~ "•? (CC_~?C:r'c ^'.emg~ or br_^rral nam,r;r
<br />s) rf al' sal; ]t. n'Ca5'1rCmCU'S
<br /> fp" GaCF, Jara.'irri rr C~o I<'.~ :ed d I _r~u " '9nli9l'U.'P Pel''JA'~', ':''. /nxilnunl' a-'C ",vhll." ~ " a', nCYi^aII) E:: E~C.T,C hle"
<br /> anS for mvas~, rmcals GJign ^~ d- Ig ~nlr'T(L'M~ PE•nod" (~'¢;¢ -C 'r L'l'CI,'.1:ia nllil F.ArrtA:i J:.a tlnl'1.
<br /> rC: llir~'T.]nt' Ea"" ~~-Cay 2di:£~C C sa^ tb• necsa re me nls under "AVf .'0)
<br />~C," c" r' '=niCl' ~'~ :1X" IJIn 7-i,^: )' 2t'Cr~_,f
<br /> of ;amp !c mcasL!rcncn's obtai~:d du:- -
<br />j ;rnndoring period under ".'.;crirnv•n. ")
<br />5. Ericr"?crmir Req~•irame,r!" iv; ecc!- ,' ~ram.clr.r nr.dcr "Quantity" ar.G "Q.'n'ity' s s; "cfir: i't pc mtiC.
<br />'. U'der ',;o E'r' _: cc" nulr Ee: vi r v!e mcr a~:nents during mcn~'oc ~.;; :;cJ :he[ ' ~r ~' nz:.i•nrm (anE:'t
<br /> ~ainimttn or 7-day a~r^rrgr. 25 apprv;- "e) pe ;r'.:t ~ cgniremcnt for c~c~ ~~ ~~tre-, ' ~ *lorc, ':n;r "~'
<br />i. ~' ICr 'Frerjue.iCy oJ.a,ralYsis" 'J¢LF . . ".~'GUIf'e ,i.'e C.MrnlCr r° (ari'[aJ rC ~CCnD ''~ x!^' ~'ng ?n. iJl',iy'S!5 Gf r•(
<br /> daring nlaml]~ng peri„d) a,tc' vs "Y' v,ril Rcovi,eu;enr" specified ie ^,-tP (c ~• En.^ 'Car" fer continue s
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<br /> mnniln i tg, "I '7" fo! one day pct tct`" , "l/3~"
<br />-or one da.y per momh, " 1 X90" fo: ^ ,day pc " ntLrter. eL:.)
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<br />9. E:ler "~.vnpre TI e" `vi~t as "Sams'- .'~Iens~•rem^rr" (actual sample I~!]c use: .u `..t; rn_ni!v~ng pr.iod) and ~s
<br /> "I'enn~' Requir~nani," (c.g., _''r.r ''rcn" f.,r irdividual camp'?, "3rIlC" 'o' 2d-ho: ear pcsi[2, "VGA" -].
<br /> contim~otts monitoia;;, vlc.)
<br />?0 R'hcre vtolal'cns rf ---tit ~c:tircur ds , rc rporlcd. alLnch a brcf es~ia^at'o'. L dcsai-: r is?and cer'ecl :e
<br />actions taken, tnd re~rrcnce each ci']la-Ion ~y date.
<br />11 'f "no rlise~arg e" oac~s doting mor(:ring xrcd, enter ",1'v Dischoroe" ucress ''1 --' in p:cc< of •at~ er U;.
<br />1?. Enter "i''ame!^itle nJ1=-incipu! I'r;c,.hve O,~ice," with "Signature aJPrincipnl F'recui •: (7;"car n`-9utha-i.r'J
<br />Agent," "Te/epnone i', io.rbc-," zr d "D^!s" at I:v:!om of Conn.
<br />13. Mail signed Rr:por! tv ~F-ce(s; by dr'r(s) s^.7ci ied in pernlii Reta ~. copv '¢- yroar :.cores
<br />i4. More dEailed inn roc: c. s for use o' "'"is Di.. Jmr,%e .1lonirorin~ Repurl(V; IR) fr ° may he obt.tinet fnm Olfiu s)
<br />specif.-d in permit.
<br />~ ~ ~ i~.i~ 2e ~
<br />71t1s report ?. requirzj by rau• (33 U.S.~. t I8, 4' C.F.R. 125.27). Fa !v-e :o resc : o. '^_~!i.c a r'. :o' t "atf fit?ly n r:
<br />remit uI civil penai,is -~' ':o e::c.~.•1 ,^,'_D,C"'I ,e. r'~ y o: violation, x iu r:~rri ~.': pe]r'.'~e., o: 't .::c°_ ' St5,pJ3 per c~ y
<br />cf violation, r~ by nor-;nnmea[ f~, nvi Te-~ th-r o;te }ear, or by both.
<br />PPA Farm 3320-1 (Rev. OS ~)5)
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