Epa Form 3320 1 From PDF Details

The Environmental Protection Agency's Form 3320-1 is a questionnaire designed to help the agency gather information about facilities that may be emitting hazardous air pollutants. The form is used to determine which facilities are most in need of regulatory attention. Completing the form is mandatory for any company with the potential to emit more than 25 tons of a single hazardous air pollutant or more than 10,000 tons of a combination of hazardous air pollutants annually.

QuestionAnswer
Form NameEpa Form 3320 1 From
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesfalse, 24hc, Form, 1

Form Preview Example

PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different)

NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)

Form Approved.

DISCHARGE MONITORING REPORT (DMR)

NAME

OMB No. 2040-0004

 

ADDRESS

PERMIT NUMBER

 

 

 

 

 

 

 

 

DISCHARGE NUMBER

 

 

 

 

 

 

 

MONITORING PERIOD

 

 

Check here if No Discharge

 

 

FACILITY

YEAR

MO

DAY

YEAR

MO

DAY

 

 

 

 

 

 

LOCATION

FROM

 

 

TO

 

 

NOTE: Read Instructions before completing this form

QUANTITY OR LOADING

 

 

QUALITY OR CONCENTRATION

NO.

FREQUENCY

SAMPLE

PARAMETER

 

 

 

 

 

 

 

OF

 

 

 

 

 

 

 

 

EX

TYPE

 

 

 

 

 

 

 

 

ANALYSIS

VALUE

VALUE

UNITS

VALUE

 

VALUE

VALUE

UNITS

 

 

 

 

SAMPLE

 

 

 

 

 

 

 

 

 

 

MEASUREMENT

 

 

 

 

 

 

 

 

 

 

PERMIT

 

 

 

 

 

 

 

 

 

 

REQUIREMENT

 

 

 

 

 

 

 

 

 

 

SAMPLE

 

 

 

 

 

 

 

 

 

 

MEASUREMENT

 

 

 

 

 

 

 

 

 

 

PERMIT

 

 

 

 

 

 

 

 

 

 

REQUIREMENT

 

 

 

 

 

 

 

 

 

 

SAMPLE

 

 

 

 

 

 

 

 

 

 

MEASUREMENT

 

 

 

 

 

 

 

 

 

 

PERMIT

 

 

 

 

 

 

 

 

 

 

REQUIREMENT

 

 

 

 

 

 

 

 

 

 

SAMPLE

 

 

 

 

 

 

 

 

 

 

MEASUREMENT

 

 

 

 

 

 

 

 

 

 

PERMIT

 

 

 

 

 

 

 

 

 

 

REQUIREMENT

 

 

 

 

 

 

 

 

 

 

SAMPLE

 

 

 

 

 

 

 

 

 

 

MEASUREMENT

 

 

 

 

 

 

 

 

 

 

PERMIT

 

 

 

 

 

 

 

 

 

 

REQUIREMENT

 

 

 

 

 

 

 

 

 

 

SAMPLE

 

 

 

 

 

 

 

 

 

 

MEASUREMENT

 

 

 

 

 

 

 

 

 

 

PERMIT

 

 

 

 

 

 

 

 

 

 

REQUIREMENT

 

 

 

 

 

 

 

 

 

 

SAMPLE

 

 

 

 

 

 

 

 

 

 

MEASUREMENT

 

 

 

 

 

 

 

 

 

 

PERMIT

 

 

 

 

 

 

 

 

 

 

REQUIREMENT

 

 

 

 

 

 

 

 

 

 

NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT THIS DOCUMENT AND ALL ATTACHMENTS WERE PREPARED

 

 

TELEPHONE

 

DATE

 

UNDER MY DIRECTION OR SUPERVISION IN ACCORDANCE WITH A SYSTEM DESIGNED TO ASSURE

 

 

 

 

 

 

 

 

THAT QUALIFIED PERSONNEL PROPERLY GATHER AND EVALUATE THE INFORMATION SUBMITTED.

 

 

 

 

 

 

 

 

BASED ON MY INQUIRY OF THE PERSON OR PERSONS WHO MANAGE THE SYSTEM, OR THOSE

 

 

 

 

 

 

 

 

PERSONS DIRECTLY RESPONSIBLE FOR GATHERING THE INFORMATION, THE INFORMATION

 

 

 

 

 

 

 

 

SUBMITTED IS, TO THE BEST OF MY KNOWLEDGE AND BELIEF, TRUE, ACCURATE, AND COMPLETE.

 

 

 

 

 

 

 

 

I AM AWARE THAT THERE ARE SIGNIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION,

 

 

 

 

 

 

 

 

INCLUDING THE POSSIBILITY OF FINE AND IMPRISONMENT FOR KNOWING VIOLATIONS.

SIGNATURE OF PRINCIPAL EXECUTIVE

 

 

 

 

 

 

 

 

 

AREA

 

 

 

 

TYPED OR PRINTED

OFFICER OR AUTHORIZED AGENT

 

NUMBER

YEAR

MO

DAY

 

CODE

COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)

EPA Form 3320-1

PAGE

OF

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