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<br />r P'a'perwork Reduction Act Notice ~ ~
<br />'ublic re;~nrtinF burden fo•~ tts colLxrion of information is est mated I ~ rcry `ror a range of 10 hours as an
<br />~rveregu p.r ~s",crrse fie; soy a --iinor facilities, to 110 hours a5 s, :.~:ern;;, ,-~• ~esponse -or score najor facilities,
<br />~+vith e wr.~g~ted evei~~~ ro nc,~o- and moor iac~li[i us of 18 hcus ?er ~.,oss:,, including rim:; for reviewing
<br />rstvctio ~s, se.,~cb ~!.- cxis .r ~~ cFia sr!rces, gathering and ma~nuinini he daC; needed, a.nd completing :md
<br />-evizwmg tl:~, cr!le~aia~: of ~r -ur~etion. Send cr.mments regard ~ [hE ~rd~_ estimate nr any other aspect of
<br />'his cellettinn ^,` i ~fe~_~aGcn, .,e'uaia~ suggest ons for r„duc ~ ~~ .hJs :!rt~::~, to Cl.ief, !nfermation Policy
<br />3rauch, F;'!, 223, U.S. env o-~_nental ~=ro.ection Agent;, 4C] ,Y:.Leet, =~,Y Watihing[ou, DC 2(460; and to the
<br />Dfice o` Inlorm-tlca rs.d R:,o ~I,tory Affairs, Office of Alanagzment end -udbet, Washington, DC 20503.
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<br />General Instru ctio~ls
<br />I. If forno has ~~een patial y ccmpleted by preprinting, disrega.Y ins[:~~ctions directed et ertrr of that infcrtncCon
<br />ahead}~ preprinted.
<br />Z. Enter 'Permrrlee .\'mne 1~:oiling Address (ard facility nnn,rlora^: -: riifferen[)," "Pe•mit Nwnber," a,td
<br />"Di.:c(,arge A'umber" whe-e irdica~ed (F, separate form is re ;,ti ed fo; : ech discharge.)
<br />3. Enter dates b=ginning and coring :\lonitoring Period" coverer' ~;~ for ::~itere indicated.
<br />4. Enter each "Parcmeler" s ::~ecified i~ manilonng regnircmcn's of pe,* ~~..
<br />5ntcr '.Sunpte,L'ea~-~%e,s .' dai"~ `.' e<^clt nammetr,• undo: "Q.ran~ih~' ~n~ "Qvelily" io uniL sp~rr:if:ed in permit
<br />"~iv^: rge' is non Wally a~ ;~:~^.aic r~:- age (geor ~c!r.c a,~r age 'c''oac:c a~aTe'ers} of a~! s.tmple mcasu~emeu[s
<br />ror taro -~ar-meirr oblai -c ~ d,~=ng „monitoring Y•'. cud"; "'Jn•~i.ntm~` -^c• ".', rin;;.rv+n" urr. ne~rt.Jh eatroac !t.1Sh
<br />rod ;ct; nr°_;o;cmrnls ~~h °.~ae', d:ri,rp, ",,1onilrrring Pr•rinr'. i•~'^ . ,c municipn!s tt~!'a ;econdar} tt.:atnter.
<br />requin;m :at Er!cr 111-day gage o`samole incascrcments t de. °A: c,•oge," au ez:cr naxim~^~~. 7-p',~y avr. age
<br />of stmplc mr~sZtrements cb z'; cd clurn;; monitoring period under ",142~ir„~crt.
<br />5. Enlcr "Pcrmi~ Rryur: a~ia,,r fins ea=:• parameter order "Quanli y" an=' , ~ ~alihl" as scc~'ed in permd!.
<br />7. Under "?b ~~' :,-. ,*~...,..r of ssmple meaeurmcnls daring rnonlb:'~ng ; ^c. ~~at ^xcr'rYt mztimum (arc'rm'
<br />minimun or ~i-d.a~ ar~crn,c ~s 2,)7ron'i:.te) per*rit rcquircmer.t L-~ ca.r ~ ~: ^:-,cle•. if area, cnCr "0".
<br />3. L-~hr: "R-eg~::nc~. uJA,.rr o~+s" bn'h as "Sarnp~e ;~lemv;-rn~nr' (ectu•~ "re;uc~c;~ o" s=:~~li^g ~n~ an~1~~.~=is u~l
<br />dur.ng n ani!~ring F r.e•) ~ ~c a "..°rrmi Hegvirenren!" spxi"ed in 1i'. (c.,., c:ae: "Cm,r," fog conlinuoes
<br />tnonitnrirg, "1/7' fe' one t~:~.;~ r-. t;c.k, "1130" for ore day per moni)t, ' ~c90" fo' ore day per quarter, etc.}
<br />9. Entc~ "Scrn/~!e Type" bo°: ^s "Sample ;llearvremcnl" (actual scmnlr, ~. : sr_I duri tg monitn,ir.g period) nrd as
<br />"Pe.",nV 4eq~iremenl," ;c. ;., Hale- "Grub" for iadi~~idual ra~nple, "?~11(C" for 21-::our composilz, "A'cA" fcr
<br />con:in~ocs moni.oring, e.ct
<br />'~. Wh.•c ~~ic'.a:~~n~ of ,_t77i~ cauir_rents are reported, a'Ldt r ~~ref ~ aaratioa 1a describe .auce and co~ec[ivc
<br />zcuons taker,, and reference each violation b}' date.
<br />~ L If "nc jis h^ r~r." a;c ~ rs ~ .ring mcn'torin~ period, en!er "No Dischorne' across form in place of data en(r.•
<br />?. E~tlcr "Arame/I'irl- of PrS,cioal F.xecuNve Dicer" vAth "Signature o,' Principal Ezx~~ti•~e C~cer aJAv~horized
<br />AgeN," "Telephone ,\'um„c,-," and "Dole" 2I bottom of form.
<br />i 3. Pdai] s,gned Report to f?rc_(s) by G: It(s) specified in permit. Retain cn;n~ for your records.
<br />14. More dcLailed irsWc'_o-s fs use e''his Dischnrpei:>onilorin•; nepor? (7.d•R) form may be obtained from Cpice(s)
<br />specified in permit.
<br />Legal Notice
<br />'I'is rcpoR is r~qu~ -~ t:y 'aw (;3 U.S.C. t3' 8; ~0 C. F.'t. ]25.?7). °~i:u"° !o rapo-t or fL'i!w2 to ,eport truth fi d!y car
<br />,esat in civil nenaS[is rot !o e. cow' "10,C9J per day o` violation; or ~., trim n:' penalties not to exc::ed 57S,UP'J per de,
<br />of violation, or by imprisonmer.: for not Wore than one year, or by bola.
<br />'EPA Form 3320-] ;Rev. 08-95}
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