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- - -~'.1=;°`s'ork Reduction AL.~: 2aict~ - - -----
<br />PubFc : ~;xxtice hur~:n f.: '.ha , .; !rzhon ~f .,. .. , i~ n is estimated tt vary from a renge of 10 hours as tm
<br />aver ve Prr re:+.xm~r !nr s.: re mi•: ~r facie; ~.. ' ~' .r ~. as ao average Irer re::poose for some majoS facilities,
<br />ui:h a .i~ighte~? avz;_ge G r uuja:~ ,..mJ ^;.r,c; ......:. ~ .f .F' hours per rexpo~.e, including time for reviewing
<br />ir,.,ln:.__..•;u. .,.-a rrsi;:,~ ex ~. :.cg .'i.: ~. ~~ar.:~<, ~~~,.-: ~ '..d n~ru.lainin; t~.: _' ~ nc.dul, and complelidg and
<br />„r.,c~~. :: !~ :he .:u;!e,;;i.;n c: ,ntoni u;iun. Send wrrunenls re;ga,rdmg the ..lC„1~;. ectiurr[e or any othet aspect ~of
<br />t:ris ,,;'~,ec;ion .:f ~._it•nnt. . -., s:.:d~r,;; ;e,;gcstiu::: .~-~:riug the; ~~urdec, to (~izf, Information Policy
<br />n r.u:ch, P1?-223, S. Er.i .:uarntn ul Pi utution Agrnc. , ~'Ql :vl Street, :;'N SVx~shington, DC 20460; and to the
<br />Otticz rf Infiinn:io,t .old ~ ~;;u'z:or+ Affairs, Ofticz of ~1anagrment and I3udgzt, Washington, DC 20503.
<br />General Instruction's
<br />1. If form has been partially completed by preprinting, disrc;gard instru;l.ions direc4~d at entry of that information
<br />already preprinted.
<br />2. Enter 'Permittee Name/ltfoiling Address (and facility came/locatior>, if di8'erenQ," 'Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for itch discharge)
<br />3. Enter dates beginning and ending "dlonitoring Period"covered by form where indiaded.
<br />4. Enter each "Paremete," ~ specfed in monitoring regtriremrnts of perntit.
<br />5. Enter "Smnple Alerrsu, euunt" ,L~ts for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />".; rr~roge" is rormall}~ ;;r.thmctic average (geometric avenge for bacterial parameters) of all sample measurements
<br />Cor esch paran;zlcr ut!zlrzd dunng ''Aloniloring Perod"; ",tfaximurn" and ",5fininwm" are normally extreme high
<br />and low measurcmens , ~tain:d dunng "Afonitorvrg Perod." (Noe to municipals with secondary Vealrnenl
<br />requiremrnc Enter 3 !-i: ~ average of sample mcavuremenls under "Average," and enter maximum 7-0ay average
<br />o(sample mcasure:ueca: c~taircd during monitoring period under "A•Im•imum.
<br />E. Enter "Pernir Req~irr n,r,„" Cor e.:ch parameter under "Qumrrity" and "zualiry" as specified in permit.
<br />7. Under "No Ez" enicr r~.::nbcr of sample mtasunnents dwing monitoring period that exceed maximum {and/or
<br />minimum or play avcr.:,;e as aup;opriate) permit requirement for each parameter. if none, enter "0".
<br />S. Enter "Frequency of ~I: o!v.is" Lolh as "Semple ,Ueosurnrent" (actual frequency of sampling and analysis used
<br />dunng thonitoring pczi;:) and ;rs "Permit Requirement" specified in permit. (e.g., Enter "Coot," for continuous
<br />.monitoring, "I '7" for Ana av per •.veek, "I/30" for one day per month. ' I X90" for out: day per quarter, etc.)
<br />9. Enter "Scruple Ttpe" b_th as "S'amp(e ,tleasuremerv7" (actual sample qpe used during monitoring period) and as
<br />"Permit Requirement," ~z.g., Enter "Grab" for in'ividual sample, "3JHC~ for 24-hour compdsite, "N.'A" for
<br />continuous monitoring, arc.)
<br />10. Where y~olaliens of ,~eu;tit regwrements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and refzauce each violation by date.
<br />t 1. If "no discharge" xa.rs luring monitoring period, emer "No Discharge" across fornt in place of data entry.
<br />IZ. Enter "Nome/f„!e cj ~~.r:eipal txeccYivr O~ceP' N7Ih "S'ignalure o'Principa! Esecu(ive O,~cer ojAarhorized
<br />.4gen7," "Telephone A':rr.ber," acrd "Date" a[ bottom of Enron.
<br />13. Mail signed Report is Cftice(s) by date(s) specified in permin. Retain copy for your records.
<br />t4. ~4ore detailed inslruc:let!; ter Asa of this Discharge ,5foniroring Report (DMRJ form may be obtained Crom Office(s)
<br />specified in permit.
<br />Legal Notice
<br />T'b,'s report is requirr~ by !.,w (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure rto report or failure to report truthfully can
<br />result in civil penalties not '.u ~ ~.ceed 510,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />of violaticn, or by imprisorrnee[`or tier more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 0?-3-">)
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