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Pape><•w'ork Reduction Act Nol:ice
<br />Public reporting Lurdra for this co?hxtion of information is estimated to vary Fom a range of 10 hours es an
<br />average per response for some minor Facilities, to 110 hours as an average per rzsporse for some major facilities,
<br />wirL a weighted :,verage for major tmd minor facilities of 18 bows per respons„ i eluding time for reviewing
<br />instructions, searching existine data scurces, gathering and maintaining [he dat+ r;eded, and compietiog and
<br />reviewing the collection of informatim. Send comments regarding [he burden es:ima[.: or nay other aspect of
<br />this collection of information, includui~ suggestions fur reducing this burden, lc Chief, Informa[ioo Policy
<br />Brmch, PM-223, U.S. Envirornr;ncr. ~;o[e~tion Agency, 401 M Street, S`1J 1!'s~ra.g[on, DC 20460; and to the
<br />Office of Information and Reguletoq• Affr.irs. Office of Management end Budget, 4'rshinglon, IDC 20503.
<br />C'' erleral Instructions
<br />1. if form has bceo partially complete( by preprioling, disregard instructions d~rxted at endy of [hat information
<br />already preprinted.
<br />2. Enter 'Pe-mirfee NameLL.'a.!ing A~adref.r (and factliq• rtamc/location, i' [„T_rcrQ," "Fermi! '.-'umber," and
<br />"Gr.cchargr .4'u.nbe~" w~hcrc sndic,'.x'.. (4 separate form is required for e~c~t c~s_hr rga )
<br />3. Enter date: beginning and cndi.tg '3:umrnring Period" covered t; form wacrz i idral[:d.
<br />q. Er.tcr each "Pc•ameler" as sp~:cifi:l ir. monitoring requirements oCpcrmi[.
<br />5. '..^ter ".Somp!e ,llensvremrr ~" raCt 'n' :ac't p camc;er under "Q:.~nriry" and "'v~~~!!-' in touts specified in pemtit
<br />"4~•~rage" i; ^:nrcil h~ art tlraG~c ;. r); !er^mcu is a•. ernge fo: baclcr..^_i -- _~-; of all ;ample measurcm;nrs
<br />ra rich • -=r -ter obL~ic..c~ ri.P.C; ~'.'cn :aru7,l; P:rMe!"; "1:ar mmn" '. d • r. urmn 'are iiormall} cMre ~,e h g.
<br />uui low m;;;;_:rcmcr,ts eb:= ,.cc _r.i~~ ".Uomn:rrm; Pcrrud." (~lo'c w ~ i i~';I; •,.al.. sccon;i.~ry tr:a'~.t.c.
<br />recuiremrrt: '~rtcr l!` day t:r~-~ • ..-rui•p!~: mcasurem^nIS un~_r "Avrre~ , .. ~:cr m;rcimum 7-0ay ave;::gc
<br />n' sr;nplc rrca ureuteuls ob aiu~d t ~~: ~~ r •~oni;oting period uadc' " tLr.?'inr ~,,: 'J
<br />G. r.ucr "Per,r~i' Zegvirrment" Cyr ea~':• .r.~n~neter under "Qunnrih' and "Qvr L.~ ' ~ ~; c_ifed ~a ocnri~.
<br />7. G~ a•r ",\`c 'enter nu. ~.:,.r o' ::, n ~ :ttasunoc~is duii,g o-o:r'c- .. !r: "ant ,~ .. ,.nom (anc'%c.
<br />mLiinmm u~ 7 [Lay accra~c 's apnnp~ ...:) ocrniit r:riciremcr ~ fw r~-h r,,a; . _~. ,~rt~uc, r. ~... :~
<br />8. Eiu'r "Freyue~cy oJAna!s~.cir" bc[h as "Smaple bleacur-men!" (actual Lay.; .r}~ of stm~~!r; and analysis u_':c
<br />during moaito~ing period) , { as "F'~rrri•.Zequiremen!" specified in pcnni~. ;c. g., Enter "Cant," forcontinueee:
<br />monitoring, "1 .~" for one day per va c, "f c30" for one day per month, "1/90" fo: o-~e day per quarter, etc.)
<br />9. Enter "Sam,~le ~tTe" both ~s "Scup'^:~f•o.etrremen+" (actual sample ty-,c usr' c'trir; monitoring period) 2r,d a~
<br />"f'.vmi! Rrq,u •vmenl." (e g., '~td:r ",nb" for ir.dicidual sar•ple, "?~1G(" Co- 2~-hour ~ameos.te, ".biA' "or
<br />continuous mo tiloring, etc.)
<br />10. Where viotaliors of permit n;qui ~cm ~nts are reported, attach a brcf ca;aw ~! :r.i ;o :!cscri6+: cause and cm ~ec:~cc
<br />anions taken . nd reference etch •: olauon by dale.
<br />I I. !f "no disclurge" a:curs during mom i print, period, elver "T'o Durimrge" across (Dart in place of data entry.
<br />l2. Enter "h'unre ~'i!!e oJPrinupo! F+e^rhve OJ~cer" with "Signa:urr aJPrinripa! xeculive Officer ojAulhorifea'
<br />Agenf," "Tr/ephone Number," and "L?.rte" at bottom of (orm.
<br />13. Mail signet Report to Office{s) by rlaC:(s) :.pecified in permit. Retain copy for your records.
<br />l4. More detailed instructions far use oC i tis Lrischarge Afnniroring Report (D,tIRJ Conn may be obtained from O@ice(s)
<br />spxi6ed in permit.
<br />Legal Notice
<br />This n:port is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure [o report truthfully can
<br />result in civil penalties not to exceed s1C~,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation. or by imprisrrnment far not more th:m one year, or by both.
<br />EPA Form 3320-1 (N;ev. 09-95)
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