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~~~erwork Reduction 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 18 hours per response, including time for
<br />reviewing instructions, seazching existing data sources, gatheting 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 />General Instructions
<br />1. If form has been partially completed by preprinting, disregazd instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/iYfoiling Address (and facility name location, if different)," "Permit Number,° and "Discharge
<br />NumFer" where indicated. (A sepazate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monita-ing Period" covered by form where indicated.
<br />4. Enter each "Paramzlar" as specified in monitoring requirements of permit.
<br />5. Enter 'SS_~rnple A4aasu:aur_nt"data for each parame?er under "~uan!iP,,"and Quali,p" as specified in permit. Avsraoe" is
<br />normally antbmc;ic average (geometric avenge ;or bacterial pa~amctcs) of all sample m~asuremcn?s for each paz:acfcr
<br />obtained duri.lg ",/aa!iriug Period"; ",Lly:4;nna" end ii/inir.:rrm" a-c rc:~mally ca;_ne high and'.oty meascrmunts
<br />ObtalnCd du~lilg "i~~Gll!!O."41r, Paris ~". (T~~C?C (O mLL"C' :1S ~:^.ul Sl'COnli:iPj 4eahncrt : :tuirement: Enter 30-day ava~gc
<br />of ~zmp'.e rrearwen-e~is under "fivz.~~s,"and enter ~, ~;`nu~m 7-day cve~agc of srn~,,',o measm~ements obtained duin~
<br />monitoring period under "i~lazimurr.")
<br />u. ;.~+cr"Ftnri!Ise:!z.^.',nnatt"foreacbparamelcnm%_ n.r,,;i,_"r,"fir„h:;'"assp:;if^9 inpe-mi?.
<br />7. Und.r "1,%. Es" .... ~ n~~mbi: of szm; le nl:,svcmcn+ Lung .roc::. ;~" ~ _'-~~ [~ :' .. ];;u mceirnum (cnd/cr min;mwm
<br />cr7;t..ya~~r~:~casepp;opdate)emitreyu~r;ncntfor,.uch;,a~mete:.~iCnune,em "~~".
<br />8. Eufc- "F: °/„•n_;• %f~Luiyc%s" both zs "S: ,,i '' ;~1:.~.1~, _.,,_ ,r" (ach cl L-u~u_-cy a" sampling acd erzlysis 'sed dur lt;
<br />iT On::OTing j)er Od) ~.IIC a5 "1lJ,b U! R.:QL!~1': ui S.'!"sp..Clr,_i Irl tl,'.ll""ill'. (C.g. ~niCl "~'.il!," i01 COnii1:l10LLS 7~OnitOrfllg, "1/7"
<br />f~ ~ oue day p_r ~; ce:c, "1/30" for one day pdr month, "1/90" frn o~:c e: ry pr-~ quarto-, e. ~.)
<br />~. ~n'cr "S_rn,F!= TyE~"both as "5~,,,, le 6; ~,~r. _,,,:.a";, :['_ ,t sar. ;lc iyj.c used durr;,- ;ooni.o~n~ ocricd) and as "P~,lai-
<br />R,eauirau_.tr," (e.g. Pinter "Graf-" ier individual =e.*,p!c, "?9.1"" for 24-F c, composite, "iJ/fi" for continuous
<br />monitorng, etc.)
<br />10. ~?/here violations of permit requirements are rc,'.ortc:', utwch a .;. ;c" acplcnurion In ?;sc:ibe cause and eoractive actin,ls
<br />to be taken, and reference each violation by dste,
<br />l 1. I; "no discharge" occurs drsing mc~ ~tor~ng perio~, ca:, r "1\'o P ier, ~ar,;_" acro~ ; :or.r, `~ ~ lace of data entry.
<br />]2. 'inter "Nam=lTillt cJPr:%rciFal F.xa~u!m, Gj~i;=, •' w;rh "S;evz~teo~a of F':ia_ir~r fr~,:Niv~ G~_•rr uJArrtlr.;isd
<br />Agent, ""Talap{rna Number,"and "Data" at bottom of form.
<br />13. 1l4ai1 signed Report to Cffiee(s) by dates) specified in pewit. Retain copy f ;your records.
<br />14. More detailed instructions for use of flis Discharge rYi~mhoring R-p,;-! (DhtR) folnn may be obtained from O~cc(s)
<br />specified in permit.
<br />~.e~c~fl ~®~ll~~
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can result i^
<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. 03/99)
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