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Papei:•w•orlc Reduction Act Noi.ice
<br />Public reporting burden for this collrxtioo of information is estimated to very ~nm a range of 10 hours u ao
<br />average per response for some micor `ac :lilies, l0 110 hours as an average per respor=e for some major facilities,
<br />wish a weighted average for major rid minor facilities of 18 hours per response, i^duding time for reviewing
<br />instructions, searching existing data soxces, gathering and maintaining !be daa needed, and completing and
<br />reviewing the collection of infommation. Send comments regardicg the bur~en csiimaL' or any other aspect of
<br />thi; collection of information, includir; suggestions for reducing [his bu den, tc Chief, Informatie^ Policy
<br />Bnmch, PM-223, U.S. Enviro~'tnenbr~ P rot~aion Agency, 401 bf Street, SR+ 14'w ungtoa, DC ]0460; and to the
<br />Office of Information and Regulatory Al~-airs Office of Management and Budget, 1Vrshitrgton, DC 20503.
<br />General InstructYOns
<br />1. !f form has been partially competed by preprinting, disregard instructiors d~rs[ed at en[iy of [hat informat~or
<br />already preprinted.
<br />2. Enter "PenrriCee Nnme!'Liarliag Ai'dres (and facility ttamrJlocatio-t, if [ ff~rcr.i)," "Per;ni! A'umber," 2nd
<br />"[)isrharge ,Vu~nber' where ir.diccCd. (A separate form is required for e;_ch di ;r;hr •ge.)
<br />3. Enlcr dales brginning and ending "Jar;ror,'n,{ Perror/"cov'ered by form ~::hre : ccat[d.
<br />4. Enter each "I'c. omarer" as sp:ri[ied is monitoring requirements of permit.
<br />5. Enlra ",San Pte dfensvremenr' data fe c'u:h paramclu under "Qranrifv" ~^d "C~arir:" in uric specifed in pcrnut.
<br />-rgte" is v~rnudl}' arith:r^tic .:,°: rite (eromctric average fer bxter.2' ~a~ ~. •rsl of ^~' "sn,Ie r•,easuremr~t~.
<br />for : ch pnru: r1er obtatr:cd ':tin ~ n :nrrn¢ Prri,rrf' ".flax.mr:m„ a :f 'V;i,r r,:,,..,' ar: z-m31!~; cslre:,:_ ~, ,`
<br />unn tow mc::: ~-cmerts ob.a n_t+ 1 i-., ",llnnim+:nf: Period." (Note to -~p^.!s .. L'i eca^:.t: ry lrct~• rt
<br />rc::,iremer+ inter 31!-da} a~ r'2^: o'sv ~p!e measurements tm~c~ "Av:v ;•;^ ~.:. en~~r m;°'mum'!-dny ar;:-•,c
<br />of ;::male rr_r: urcm~_nLS obl~in~:d [ ~,~r ~- . mni!oring period udder ".Vesi~~arr.: ", "
<br />G. T-: ;cr "PernJf.;equiremenr' fir e~ ~ h ~:r ~ame~er under'Quanri.ry" u;~d "Q•n~'ily~ rs ^_ cri~cd ~~ ;ern ~ .
<br />7. IJrdzr ",1'u /'~' enter nwr~~cr of >ai.~ z measutrr'nls' d~rring .rer~•7~ - i°! tF::: ~.,:c :~' i:num (~a['c~
<br />mi utm~m o: 7-ay a; c:-ag_ as a;fnP~~ - ~; permit r_ouircnun. fog carte ..:~c..,. ~` ro?:. c: ': , "~",
<br />8. Enlcr "Fre:luency p(Ana(t:as" both as "Snnrple 1•lensunnenr" (2cttr?i f =oo~. n oC sampling and analysis ured
<br />dwing moniroring period) .md a: "F n:ri' Rrgwrrnrenr" specified in pc-nu [. ;c. g., 3ntcr "Coot," for continun~
<br />moni!oring, "1 7" for one d:,y per ,lee ~., "130" Cor one day per month, "1•iG" (o mtc day per quarter, ctcJ
<br />9. Enter ".Sample Type" both 's "SunrP:^ dlcasuremenr" (actual sample h?:c as-o '_'!rin~ monaoring period) and as
<br />"Prrrrn! Regui^emenL" (e.g. I'_r L:r "r";rrh" for individual samptc, "_'JHC"' o' 2d hour romposue, "h':4" ~o~
<br />continuous mo iitoring, etc.i
<br />'I0. RTete violaticu of permit rrquin¢ ~nls' uc rcponcd, attach a brief exp':!na'~ ~~. o describe c:rusc and carectivc
<br />actions taken, rind reference each ~~ of uou b} date.
<br />I1. II"oo disclsug:" acurs during mu tit ring period, enter "ti'o Dr.rchorRe" acrms !crm in place of data entn.
<br />12. linter ".'Varre~5irle ajPrincroai Pier rri,a~ Officer" vvuh "Signnrure ojPrinnp•r! 3.recrrrive Cl~cer njAurhorizarl
<br />Agen!," "Trleplrone Number," anc' "Date" a( bottom of Corm.
<br />l3. Mtdl signed Report to OfFice(s) b} rla!c(s) :pecificd in permit. Retain copy for you rewrds.
<br />14. More detailed instrrctions for use cf', us ('ischarge dionuoring Report (D.17R) C rr- may be obtained Gom Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This n:port is require:[ by law (33 Lt.S.('. 1318; 40 C.F.R. 125.27). Failure to report or fa lure to report truthfully can
<br />result m civil penalties not to ezceul S 10,300 per day of violation; or in criminal penal rtes not to exceed 525,000 per day
<br />of violation, or by imprisonment for not mole than one year, or by both.
<br />EPA Form 3320-1 (A.ev. (18-95)
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