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Paperwork Reduction Act Notice
<br />Public reporting burden for this collecti/n of mformztiuu rs estimated [o vary from a range of 10 hours as ea
<br />average per response for come minor fa.:dines, to 1 i0 hour^ ac an e~erage pr- response for some major facilities,
<br />with a weighted average f/r major and ;nin~r fa~ilihe" ui 18 hours per rz.~:oose, including time for reviewing
<br />instructions, searching existing daa sourc:s, 8athrring , ^d maintaining the data needed, and completing and
<br />reviewing the collechr•n of infonnatit:o. irnd cnrttm~nts regarding the bur}en estimate or any othec aspect of
<br />this collection of information, inc:uding ~upyestiurs for inducing this 6uruen, to Chief, [nfortnation Policy
<br />t3rsnch, PM-223 U.S. Environmental Prot:otion .lgoacy, 401 M Street, SV,' Washington, DC 20460; and to [he
<br />Office of Infotmati~n :.nil Regulatory Afiaire, Office of ?,tanegement and Bur;;e[, Washington, DC 20503.
<br />Genera) In~:tructions
<br />t. rf form h~., h. en la,:i^.!} wc,;:~•+ed h,• ;~,rpri•+t,..g, ''~-.xgard in"t.1..tir u dir.;cted nt antry of that iaformation
<br />:.beady yrcprint~.d.
<br />2. Enter "P~rmirre: in,rcalniLng .id•i,'eir land f :ili v nam~txali~q if d6erent)," "Perini! Nu,nber," and
<br />"Ui.cc•ha^Sc .45rm%:e." ohu. !m ic:.i-d. (.~. sep;uatc hrn, .required for vac + dj5ct~~°rge.)
<br />3 Enter dat.-s h_~nmiug .,;rd enu~~~g ".t~foni~,,r;+r•~ r•'•~nd" __ vied `+~`mr: +sF rc indicated.
<br />4. Enter earh "Pa+wnerer` as co!r-ifiai it ,.~e:~.lorir.~ ren n: rcments o'p"rmit
<br />. ~_nter "~,%.1:ie Sirr. ,^r•m_:.," cL t_~ +br .>,cn a.~,.,me,er a ,tier "~luanfirv" a ~ "Qvaliry" m units specified in permit
<br />°Avrr, fir" is n~^-+.~11} ari+^ ar'^ n+'enrc (e~.•; :~i:nc:n•' .FC Cor i~,•~c~c~ia; :aram,:t~s'~ of all sample measurements
<br />for c-°~~ :ar,:mc; r chtzined d..~r g " .~,- r. ,.„ tr•, .. " an t!icr..•:n" aye normally extreme high
<br />~tnd .ow mca=:ren'r~'s o:i-.' dur•+, ,..+•n..• .•,_'." (1~•tr mw.-:ipa~s ++rih scwndary [rcaiment
<br />regtcremcri _.rv.. 10-~?+ a+.. agr ~ ,, le ~, , •.,.,.. ,.; ~:nd~r ". ~ ver c,' ';.'~+ °r.icr maxiraun; 7-day average
<br />~f sample m.•;~.a*~ u:cn., cS+ai~al d ::i rr mom. iln ~:• , ar :; ^cdcr';ilrtrim: m '/ ,
<br />f. Enter ":'rra~ .rr.. ,i; n,.,n" .cr es.'t ; ,ram, .u t.c_ ~' a6~'' mlu "Uur' };::ci:.ed in permit
<br />:. i)nda "\'r en'q un^'!,cr -~ <.n plz m~a:~..: ,.. .. rm:~g r•+•,^.^'o ~:. perioc that exceed maximum (andior
<br />miniT.~,,r o. ? ds+ :. ;g.. ;s r.pr-,r,^~' ' a:.~ ~; .,near f:r?ash pacmeter if none, enter "0".
<br />8 Fntcr ':r ~qv :r ~j .':,n:r bo.~. ,_ .' :r ry r:• ' ir•: nenr" (ic:cr:l f~ q;:enn of :;:,mpling and analysis used
<br />during :r.oou;.~.:~ ~-..,1. ~•-.d .c '; •. ,-:~1 iii,"/:r: ~•. spceified '~ fc;; ;il +~„ Enter "Carr," for continuous
<br />moui+.;nrg. "!. ".. Gar w•: ri s /.r .re.b 'nr o.._ ? .per mouth. ": D^" for one d2}' per gttattcr, etc.)
<br />Este: "`:~r,;'Ir • .r:r" bu!h :: '.\c.•~rte '~,r . °c:^rnl .~,,~~ sno'p;; +sh `used daring monitoring period) and as
<br />'Trnmr :i:r,:,"emc:^" :e,, ~.+•;.r "~;... Im ::~di.i.~,:nl caut•,,I^, "~Jl'C' for 2:-hour composite, "NrA" for
<br />•amtinuous rneniten.,g, etc.)
<br />lQ `Nhere ~'IOlatA0:,5 J, perTO;: •r{ui-rTr-r .rr • ~,:;~+ :L,c':• a hart P..:pi'~,.;,tio., :o describe cattle and cortecuve
<br />actions taken, and rt:ference each'; iota~san by chic.
<br />11. if "no discharge" occurs during r:+cr.itr. ing perirxi, enter ','~n D~srhorge" across form in place of data entry.
<br />12 Enter ";Js,ne.77r!e ojPnnripm £:eru'i~.•e C~jr•r" a^'i. ".~':gnarure ojPr~ncipal Execu(ive Officer ojAurhorized
<br />Agent," "T~(~ohon~ ~?umhrr," and "Darr rr hGD.GIt: of Con.r
<br />13. Mail si~nca Repi.rt ,o •lfficete) b} date st s,xetf rd ur perrut. ketain copy f or your records.
<br />ta. Morc dct.;iled inswctiors fur use of th ~ Di.ccha,,n ',1wr;ori,rg Ptporr (DA,R) fern may be obtained from Office(s)
<br />specified in permit
<br />~,cgal ^~ otice
<br />This sport is rrquirrd by law r'S3 L. ~.C. 1'+::; 40 C.h.R 15,=71. Failure to n:port or failure to report truthfully can
<br />rc;u;t io civil penalties not M ~xc, w i 10,000 pe: uay of viola::.n; or in criminal penalties not to exceed x25,000 per day
<br />.f violation, or by imprisonsant for ool :rnrr ti;ar, ,n:: !c..r, nr ::~ Mth.
<br />EPA Funtt 5310-1 (Rev. 0.-45}
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