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~'aperwork Re~~action Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor faci]ities, to 110 hours as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 18 hours per response, including time for
<br />reviewing instructions, searching existing data sources, gathering and maintaitting the data needed, and'
<br />completing and reviewing the collection of information, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Wasbington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Ins~~rnctions
<br />1. If rorTn has been partially completed by preprinting, disregard instruction drreeted at entry of that information already
<br />preprinted.
<br />2. Enicr "Permittee NamelMailing Addrzss (and facility name location, if different)," "Permit Number," and "Discharge
<br />NumF~r" where indicated. (A sepazate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Pzriod"covered by form where indicated.
<br />4. Enter each "Porometzr" as specified in monitoring requirements of pemut.
<br />5. Enter "S~nrple Al asrn•ameat"data for each parameter under "~iuantity"and Qualih~" as specified in permit. "Avzrage" is
<br />no.lnally arithmetic average (g,:o.nct,ic average for bac,zrial param:.ters) of all sample measurements fci each parameter
<br />obtained during "itio,ritoriug Pz,io„!"; 'Sv.'.ui.;ns;i" and hlinircmi" are normally extreme high and low measurements
<br />ebaincd da,-ing "i~ronitoring Pzrioy". (Ne;; tc municinna's with sccoudary scatmen<. requirement: Enter 30-day avc,age
<br />of sample measurements under '.;~•~ %a,"a,rd ert_r r;asim; -i 7-cam°y average of sr .tple measurements obtared d,tr~,
<br />monitoring period under "ivaxinrtinr.")
<br />6. Err e- "Pen: i!/Z.'~if1, _d1°.7f" ink erCr~ pa: mE'Ci t~ic~ ~. "~:r•.mrir,,"£.4C "~^iuvlity"as ap:cified i~~t rermit.
<br />7. Urr'c~ "?' , ..,." cct: ~urncar cf ssn,~l; n:r,., -c. , ~' dining ~nonilorln~ ixrsd t;rrt cacecd mlxinum (am or minus..
<br />or 7-c:ay avc,^ge as apprcp~iate) per.tit rcqui?::ncr' `~~ each paramexr. If none, cater "0".
<br />~. ~n[cr "Fiv/cea_y r~'.Li- ;~~:•." both : , „ ~,a; !~ ; :' ,:e ..,,.~:..." (r.=heal fr ;u°_uCy of srmpling and znalysis used duri";;
<br />mnnliO,ing p2rlOd) :..~:1 a5 "~~i ~i~if Tl_':;:~%,'_~ ._ ~:"s~z~'fi:d in pa;~iiL (C.~. ~niCr ".~,'~dl,n fOi COn tlrtll0115 m0^l[OILI~, "//],r
<br />for rmc day per rtee',;, "l/30" fo- oae r':_y nc ~nonGi, "1/90" for one day per quarter, etc.)
<br />S. ::alas "Sa,„t b: 7j~i~" ;tolh as "S_rsr,-!_• i '° ~~rr~;;i,,.%" (.:c[ual o-arplc ry,:c used du~rg monitorng period) and as "°~,rri~
<br />Rzquire~na~t," (e.g. Ent.:r ";,ruF" for ::dividu:' S1n71L, '741/" for 24-hour composi.c, 'ItUA" for con;inuo,~s
<br />monitoring, etc.)
<br />10 ~rrtcve viola.icns o. ,omit eat ~ ane~ is a -t:o'ed, cY.rch a brief exp:.tnatic~ to i esc;ibe cause and corrective actto~u
<br />fo be taken, a-d reference each violation by dale.
<br />1 I. T; "no discharge" o^c' s dur:,,g ~on`L:ink p . od, e Y.. "1!o C'schcrge" across fern in pace ofdata entry.
<br />]2. °nter '7trarre/Ti!/z c~' ~,.i,ui/,! Ii.__:r!r,- :~w _. ,qih "S,.,lr.,.. ! E: ~..d
<br />. i„ of Prnt_iF. sxtiv~ O tie: y .l~rl.'v~
<br />Agznt, ""Telep:ronz NwnFs, : "and "I'vt ~" at bottom o ` fo,1.
<br />13. i/,ail signed Rero~i to C;: cups) by ?v_t a; spcci~c% in pcnrit. Rciein copy for yuw'records.
<br />1~1. 1/~or c:e4~ii;,c instructions for us: c" I`'t Cis;;h_r;;_ ,i;.,ihuiirg ~'ltFi-i (L%:..~~ fo art may b.; obLined from C,,?ceps)
<br />specified in permit.
<br />-- *t ~ o
<br />_~~~~. ~ r~T~~~i~e
<br />This report is required by law (33 U.S.Q. 131 S; 40 C.P.R. 125.27). Failure to report or failure [o report truthfully can result ir.
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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