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Paperwork Reaiuction 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 facilities, to 110 hours as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 1 S houus per response, including time for
<br />reviewing insttvctions, searching existing data sources, gathering and maintaining 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 />Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />Ge~,~L*al Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permitta= Nome/Moiling Address (and facility name/focation, if different)," "Permit Number," and "Drschlrge
<br />Number" where indicated. (A separate form is required for each dischazgc.)
<br />3. Enter dates beginning and editing "Monitoring Perio,f"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "S~ mple Iv; ~ssuru. ~:rt"data for each parameter under "Qtrontiry"and ~uolit~," as specified in permit. 'Av.~raga" is
<br />normally aritbmdic avc age (geometric average for bacterial patamcters) of all sample measurements fcr each parameter
<br />obu.ined during "; v:uritornrg Pa,-io~'; "A~ ax~mtt.a" and IV1ini;aam" are normally extreme high and low measwc.aenis
<br />obtr fined durwg „-,uit.ring Peri/~1". (Note to mtnicipers wiih secondary7eatscui requirement: inter 30-day avcru;,e
<br />of sample m~asurem.r,ts under "Av" ~b~,": nd enter m~.im,~m 7-day avzrage of sr. maple measurc,nents obtained d~:r.;;
<br />monitoring period under "iv,aziraum.")
<br />6. C:n~~r "Pdn.:i fca;ni..;n:, : ' .c; e<cS par mcrcr t nde. "ter/w;tifj," acrd "z~.uulil)," as specified in permit.
<br />7. U~ :. "A', r.-" r _- -~,imLzr u"sc.mplu r~.erre,-_~: d~i inn irwnilci'n^ .rind thai crcecd ma.~im~_~m (cn?'or mine:~r:!
<br />o. 7-.~y a~ :.zge as ap1;rap~iaL; hermit rcquironc~ t for each panuncter.Vlfnone, enter "0".
<br />t;. ?nler "F,., _,r~y y'; ~r.~1p~;s" bath rs "S.~/,rl!a ;., .. , -„e.~'" (actual frgvency of semplin~ and ara'ys .. used dui
<br />mJ":~tnrln~ panod) f:^'i c5'T~-,:;±'l Ice;,rh-r., r„'"s~rcc` icd in permit. (e.g. Snter "~. ' "for continuott menitorin~, "1/7"
<br />for one day per wc~::, "1/30" :c- one d;; pe~ mont;t, "I/90" for one day per quarter, etc.)
<br />9. ~ntS ",.''-•ii.F/d ~+!" ' J;1(il v; " tG i r. Jlgl'G,L'rr" (liCieal sample 'lP~ LSCd durlP(,' muniforinq pencd) rr_j as " .., ,.. i.
<br />krquirt,n,,d," (c.E. L~ra- ".~,•~i•" for i.tdividuc' szntplo, "24H~" for 24-hour compos~te, 'SV/,3" far car~'i;. gale
<br />monitoring, etc.)
<br />10. \'rxre viols Hors o"i.a~,,;: r;- °--; ~•_~.~ arc ropor:ed, rVrch a brief e,:plana!ien to describe cause end °urrrct'°: c_r icns
<br />to be ta'.:en, a;rd refer~'1ce each violation by dale.
<br />1 I, if"nu dis_'ta t; :" o~c ~ d!-`r x•n''.~ in;, ; c;nd, en:, r "*:o);'sch^rgc" across form i^ p'acc ofda'a cs,'ry.
<br />IZ. F.n!er "Rrl.;~,i'Itil. "i~cy~% F.~.-_~~Jhr ~,~,~," twilr '(Siovrw~;-~ of Prirti/~t F,-z:u[iv~• Cff;~,- of ~:ul;r.r'._>
<br />Agau, ""T~7er+ho;t;; iJc~,rh~°,;"and "GNU"at bottom of forth.
<br />13.:Jai1 si;,mcd R°; nr, to C ~" cs) ;;; ' ~t ;~,; specified in pe~nit. Retain copy for your records.
<br />14. .•Gor:, c'elailec ;-s::ic:'ca5 ;or ~_.a c't`'s C;~~1/,rg: ;v;v;rit~,riab R_r,r[ (L;dd1~ form rray be obta~~ed Fnm C„r_c;
<br />specified in permit.
<br />~~©~iLI1~G',
<br />i J.~,J.~G1!l
<br />This report is renuired by law (33 U.S.C. 131f; 40 C.P.R. ]25.27). Failure to report or failure to report truthfully can result it
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment for not more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/49)
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