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Paper°wor~ Reduction Act No~t.ice
<br />Public reporting burden for this col.rct;on of information is es[itnated to vary fnm a range of IO hours as m
<br />average per response for some minor ~ac lilies, to 110 hours as an average per res~or:.e for some major facilities,
<br />with a weight:d average For m3 or rrd Hiner facilities of 18 hours per re>pons^, i~uluding time Far raviewing
<br />instructions, searching existing data. so:~rces, gathering and maintaining Che d ;~, reed:d, and completing and
<br />reviewing the coli~cction of inlo-:ma:ion. Send comments regarding the burden e;ti.oat•e or any other aspect of
<br />this collection of information, includic~ suggestions fnr reducing this baden, tc Ch'ief, ln`ormat~on Policy
<br />I Bnmch, PM-223, U.S. Enviroamenhr~ P ~clation Agency, 401 M Street, SW 1Vas iir ;toy, DC 20460; and to the
<br />' Of :ca of Informa ion and Regul:.[ory A"-ais Office of 1.lanagement and Budge:, ~.Vrshing[on, DC 20503.
<br />General Instruction
<br />I. If Fotm bas Fx:en partially cc•mp'.eterl by preprinting, disregard instructiorsr-ec[ed at entry of that informator
<br />already preprinted.
<br />2. Eater 'Penrrir'ee NgmehLirrdisg A.r'drecs (and facility ttamelloratio~, if r 7_met)," "Permit .Nunrher," rnr
<br />"Discharge ,ti'umber" where it diat:d. (A separate form is required for etch ?'schr. -ge )
<br />3. Enter dates bcFinningand ending 'h1~rrNn"ing Perrod" covered L•y Corm +s Mere i d:ca[cd.
<br />4. Enter each "Pcranrerer" az spccifi~;.i in monitoring requirements of permit.
<br />5. Enlct ".Cgmrle '.lenaurrmer,t" dar,•t ic.~ earn parameter under "Qugnriry" <i `('roNr~" iu em's sper.Eed in permit
<br />••raRe" is n~nretlly aP~anic:;e ~ - ~a~z (ea•. men;c average for ~^c!..rial ~a', •c.~~rs~ e!~!1 r: m;.le rneasurem~rts.
<br />fet ;uch • •„' .aCr nbL^~rzi ' - rn'tori.l~ Prri,uP', "t!ar;mar,~" ~-ti .'+.ur•,++" ate nc~n~ll) c~1 re ter: ~; ~'
<br />and pow ~m:c~ trcnunts o::;; nee d ;-. `.tfnrntr.u-n!p; Penod." (1`!ote 'o ~, r cep°_'° '.r:S sect^.Ir.ry trc~~n~~ri
<br />rec uiremrn '•vef lC da•, ! crr• : o- rJinp'e m:.:~urementa w~c's ".Ive, c„ • .. hr ~ti~.:!nu:m ?-0:;}. av: sec.
<br />oC -~ mple r~_'; urcrnaus oL~airo:d c a:' "~ •^ni!oring period undo ":Jgxi.nv,;. ',
<br />fi. t'r.ler "Prra::: lequl.•rrnenr' L'r eE:r'. ~, ~amcter under "Pugn;i(~" aid "[)a'iry' ?s .ipc:ified ~r. neri:~:
<br />7. U~^:r ",1b .' cnu.r mtre• o'' ; ~~~ ~ me~sutmcnts during -l~rl'^I-' _ c' .~~.;~.' n~rr.num ,~.r~c
<br />ini~lr,:uro nr 7 _ny aceragr 'S a~pr;p:~c:~:) pcrnii r ~uiremcn: (~- c~_h r ~ c .. . ^. n,.. ,..a_r "G'
<br />8. Enlcr "Frryuercy ofAngh'sr~" both as "Smnp/r A1c:nunnenP' (nett!=1 ':ce_z n of sampling and analysis u_ec
<br />dining mmvto ing period) -.rd a< "f'rrr.ri' Rrguiren+enr" specified in pcrnit. ;c. g., enter "C'ont," Cor continuous
<br />mcnimrirg, "l'T' far ant ritzy p~:r P EC :, "1'30" for one do per month, "1/90'' fo a.~e day per quarter, etc.)
<br />9. Enter ".Cgmple Type" both -s "Sv rp'e Sf,•gsure+nenr" (actual sample typ^ usr_ darirg monitoring period) and ar
<br />"P ~rrvr Rrqur~•ment," (eg., :-nl :r "',n b" for individual sample, "~d,'IC' `n 2-:-hour composer. ",1"4" ^r
<br />continuous mo utoring, clc.;•
<br />l0. N'lure etalal c s of pem'it nrqu~-~ c Baas arc reported, attach a brief ex;;i: ntC•:.t ;o describe cause and car :_ucc
<br />actieiu Lakrn, rrd refcr_ncc etch ^ el±a'nn C7)' date.
<br />11. U "no disctrugc" oc curs during mn~~:eri~t period, enter "A'o Discharge" across ~brm in place of data entry.
<br />12. L-nler "A'grne'lirle ojPrincipni E•rec:•tiv.~ OJTcer" with "Signn!ure oJPrinci,-n1 Fzeculive Officer ojAuthori:ea'
<br />Agenr," "Tcle~`tane Number," anti "cute' it bottom of form.
<br />13. Mail signed Report to Office(s) 6y rla5.(s) ~pecificd in permit. Retain copy for ycur records.
<br />14. More detailed instructions far use c` I us /tischgrgr .l4onimring Report (D,l/RJ Can. may be ootained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required b}' law (33 LI.S.I:, 1316; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exce:,d 51C~,OC 1 pet day of violation; or in criminal penalties not to exceed 325,000 per day
<br />of violation. or by imprisonment far not more th.m one year, or by both.
<br />EPA corm 3320-1 (Eev. 08-95)
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