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Use this form to submit written notice to the part 71 permitting authority of each deviation from permit terms that is required to be reported within 10 working days of its occurrence (in other words, deviations required to be reported prior to the 6-month monitoring report). Each form (or multiple forms if sent at the same time) must be certified as to truth, accuracy, and completeness by a responsible official (using CTAC).

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Last Updated: July 31, 2017