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paperwork Re~la~ction 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 far 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 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, Offtce of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form bas been partially completed by preprinting, disregazd instruction duected at entry of that information abti,ady
<br />preprinted.
<br />2. Enter "Permittee Namz/Moiling Addrzss (and facility name location, if different);' " Pzrmir Numl-zr;' amd "Gischargz
<br />Numtzr" where indicated. (A separate form is required for each discbarge.)
<br />3. Enter dates beginning and editing "Monitoring Peri~/" covered by form where indicated.
<br />4. Enter each "Paromzter" as specified in monitoring requirements of permit.
<br />5. Enter "S~rir/e rli ~zcer~;rzat"data for each parameter under "~ulnri,7+"and Quality,"as specified in permit. 'Avarsbr"is
<br />normally a,ithmetic average (geometric avenge fer bac':riat paramcte~s) of all sr ~tp!u measwemcnts for each parameter
<br />ObtEined dnnR~ "rI401!/i'd'lily^ P~','iG'S/"; ':v/,1,7.'g11tIA° and Mi.:i, .dnt" arc 9Crm21~~ CXITC;'7e hl`t7 a.7d lO1V meaSUreP :rml~
<br />Obi:.'ned Bang ";:;.eih,;'urg Pzric../". (l~0ie t0 mwlWLpalS WIi4 SCCOndary SC:iiPC.t rcquvc-ncnt: ;'Hier 30-day avCTa;;e
<br />of sample measureme, is under "Avz;ab~,"and eater ra;.imvm 7-d~} a. ~ r;,c of s: ~nle measurements oUtaircd c;a' „
<br />monitoring period under 'S14aximum.")
<br />6. Er,.cr "Perrrl,'2zanir,-,nrid"for each parameter und.:r "~rvrtit~": od "~reliry"assn :ifi:i i 1 -arnit.
<br />7. U; ~. r ",?' ~ F,.•" uotc num'~tr ur sample marsvrc _ ll during moni.ur;np„,-*• cd ;h; • ~; n:c•t. m ::,ir..:n (cn~ •'or min'. ;.~m
<br />or 7-iay avcape w appropriate) permit requirement for earn p. ;~.aetcr. L nrnre, c d_ r ".7".
<br />;. rater "F,-^:;u_n.~, .~~/~t~l}'su"both as "S ~r;r/~ i~Laarra;i_ :r" (sch~.a ;r::;o: ne;• of s- 7plio~ and rn~'yss used dt~,iag
<br />mu'ti;cin~periud) rn; ac "Fe,~,:rit Re~virern_:~t";pedficd in nc"nit. (a„ q~,i:r'. •,n/,"forcon:ineous ma'irorn;y, "1; 7"
<br />ur one cay per wee!:, "//30" fog one day per monti~, "//90" for ona day per gtar Ler, etc.)
<br />S. fat.: "S,~:q-!,: T'~z"!urth as ".S1mFlz d4sos•~reaurl" (cctual ramnlc ly~c tsel dn,-'n, :ronito- n~ period) and as ";'_n,ur
<br />IZ;vi,•_.tu„!," (..g. Enter "Gr.F" for iadividuel sanplc, '74H~" fc: 24-how c;,nposi e, "T.'/!," fur con!inuous
<br />monitoring, etc.)
<br />'0. \'hcr,: violc[icns of permit reovi ements arc iporicd, aC,re;r a briefe,:p!anr~'cm t:, c rs_riSz e wa rnd corrective aedcns
<br />to Ue ta':eu, and reference each violation by date.
<br />11. ! "'no i isebarge" necu's durn,g monitoring period, enter'To f:~senr*~ _" rc,nss fc.-s `.~, pl~c~ c"data r.'.y.
<br />12. '~uter "At_~,dd/Titk : f F,-i,r_iF ,l Ex__utivz 0~~.•, " v.ith "Si~r.~.:•, ~ rf Prin~if~1 .. ~ •rli:•. :~;:: cy` .l.••'»: iatl
<br />Ab: nt, ""T.;IeF'ee;re Artmihs~, "and "Tale" at bottom of form.
<br />13. ...a~i signed Feport to C. ice(s) by dates) specified in permit. Retain r.:py for yu~r :r^,O rub.
<br />'~, .gore ietzited instvclions for nse of this Diseh~ry_ i/.•.;titc,is .R.;~ .r !r;.i,?~ fe-t miry b:: o52:.incd from ^."Ec•~(s)
<br />specified in permit.
<br />W L` V,L W W lY
<br />•fhis report is required by law (33 U.S.C. 1318; 40 C.P.1L 125.27). Failure to report or failure to report truthfully can rosul[ ir.
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties no[ to exceed $25,000 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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