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- -- 1'al:~~.;r•,vork lltrdt~ction Act "~~{~-~tice 1 <br />?nh!u~ rr urtc,g hur,!~n !..: 1h., , i,. ~i. ' ~^' 6 <br />,. .,..,:, ~,...trm a estimelcd L' ..:r,~ I~~n•i a ran z of 10 hours as r» <br />.. :,a,c ;•.rr r. ~,p•.tcc :~ •i •.. ~,:: ~.n~:..... ie. 1"I::a, n: 110 h,.:,rs es an avrra_r~ I'~rr 'r ., cn~e fur Borne major facilities, <br />~.lith a ~t.oah!cd :.v~_r.,e '.'.- *.,q,•r .,J n:m,r IariGlir? crf ;8 hours prr rr.f,oa~,z, rnduding time for revie.vmg <br />;: u.:,,;;, .ean'hir, c~.::r.E ,. :dr,, patt:rnng anJ mainWinirg tle Jata needed, and completing anJ I <br />.c~icwc:~ the u,llan,.n . I ;r. f.+n.._:i.n. SwJ .oruT,cnt~ regarding tha b1,rJer,. c;tilnate or any ocher aspect of <br />th:; .ulk.-tion of ir,f,rm.r:',n, ir:l ring ,upoesu,ms fur reducing Ihrs harden, bl Chief, Information Policy <br />Brandt, PM-223, V.S. E;:•.Irunmr'.n!.rl Protu]iun Agency, 4U1 M Strtzl, S1+/ V.'a_ahinglon, DC 20460; and m the <br />Ufficz of information and ltegufan~r} Af7airs, Office o1 Management anJ Budgrl, Washington, DC 20503. <br />General Instructions. <br />I. If form has been partially comptetcxl by preprinting, disregard in,[ructioas directed at entry of that information <br />already preprinted. <br />2. Eater 'Permitree a'ar'rr',tlar6a}' .ia'drrss (and facility name/lopuon, if diBerent)," "Permit Number," and <br />"Discharge Kumber" var.:re irdu:',rul {A separate Corm is required Ca each discharge) <br />3. Enter dates beginning ,rd emcee :; '.11„ndorirg 1'criod" covered by form where indicated. <br />4. Enter each "Paranre;r;' ~ sp~.:c `.i~cd ,n monrlori.ng regturements of permit. <br />~. Fmcr ".1'nm/'!e ,1„ r. '.ua -:n each parameter under "Quanrrh~" and "' )uaLry" in unr[s specified in permit. <br />"•Il~t•r'l~r'" is no:r a;1} !~- :;,gc (gcou:dric arenge for ba_tl' -d pa r,:metcrs) of all sample measurements <br />far each paramctc, • ` . .. ~. "I 4,ni(urir~q Periorf'; "A4uxrmm~` and ",1!inimurn" are normally exVeme high <br />,~I'~] fC'.t L; l5U:r 1U: .' ` _• ',i r .'.'. ir,~p;r4lro i°d/IW/." (,~r)te {a IIIUIUCnpa15 Wllh seWndary lfeatnlenl <br />rcyu~rcutrnt: Enter :?':~.. ..; .,,uupie ulc.ulucnicnls under ';4renrge," and timer maximum 7~ay average <br />of sample mcusurcnlc.~.:; _,,,..:::~ i~~,eemg nunituring period under ",lfaxrmunr. "i <br />F_nlcr' 'ennu :: y:~rr,.'., .,;" ..r ~, h p:cn~uctcr under "{.'uantitV' and "Quubt}%' a:. spectficd in perms[. <br />.. Coder "So fx" e:nn : i r„err , f ':unl~ic r,lcasunrents during monnonng period that exceed maumum (and/or <br />munmwn or'-day a"~~,~! ~. s ', ;•,+:prlte) permit requirement Cor each parunuer Unone, enter "0". <br />F. -uie;r ";'ry:r~n:_I •,J ! . '-.~r" .., !1 .,- "!'::,•ipF ll::rwrrr.rnr" Iadu:J Crcquency oC sampling and analysis used <br />dt.nrg ;amlitorine ~,'.~z; :r.:l l~~~n;r h','quirrrnrnl" specified in pcnnil. (e.g., Enter "Coal," for continuous <br />nun,,!oring. ") 7" ft,r ,~, : '.:,} ,;r ..:,k "1 ~U" fcr one day per month, "I "9~" for one day per quarter, etc) <br />~). Lms ".Crmyr: 7s/•-" :n: as "'• •.lur.l/.•muremenr" (actual sample iype usai during monitoring period) and as <br />r ~>nu( krqu:rerrr n: ' ~, y , .'.:r p - po / <br />"" ~ ~ ~', "(%ruh" for irdn'idu:11 _carn Ie, ""JN(-" for 2d-hour cam rile, "N A" for <br />cnntnuous monitor n ;, r! ) <br />1 GVl~e;c ~hlations ol- .,. r<<,c ;c n:nh are reported, attach a brief esplana eon to describe pose and cortcctive <br />acuorls taken, and n(•r, ,;'~ ea..h', w!::{um by date. <br />11. If "ao disct:uge" oco.;> '..~ ir.g :: ~~.,nilor:n2 period, enter ".Vn Di.charge" across form in place of data entry. <br />!2. Enter ".\'an:e Trrlr uJ l'rinci,^el .r m.'e O~nv" wdh ".Srgnulure of Principal E.rrcutive Officer ajAurhori_-ed <br />Agenr," '7elephone A'un;5~'r," :uc "uu:e~' ai bottom of form. <br />I3 Rtail :,igned Report lc. G`1:r(s) f~,.:i:ac(sl specified in permit. Retain cop} for }our records. <br />14. h'o:e ddaiird lnslruru~ls f,r us~_ ~+f This Discharge :1/nniroring Report ,f,',biR) form may be obtained from Otlice(s) <br />spccificd in permit. <br />Legal Notice <br />T`,is rep„rt s required by I ,~ f' ' u. ~.'"' 1~1 iR; M1O C.F.R. 125.27). Failure to report or failure to report Truthfully can <br />n w!t in c. ~ .I ~ enal'i,.s m:t ~ - ._ 1 5'' ll~!;~ i'.•r -l,ry n(; iolatinn; or is cri minel ptnal!ie~a not to exceed (25,000 par day <br />r f violation, ;.r by impr.-u! .": r i,r "~1 :hurt than one }ear, or by bosh. <br />EPA Form 3320-1 (Rev. 0'!-9~) <br />