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Pa~~.~~~~r~ 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 insh'uctions, 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, FIvI-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washino~ton, DC 20460; and to the Cffice of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />~~eneral 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 "Perntitte~~ Namz/Moiling Address (and facility name location, if difFereot)," " Pznnit Ntanber," and "Gischorge
<br />Numhar" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "ivfonila•ing PzrioJ"covered by form where indicated.
<br />4. Enter each "Fnvmeter" as specified in monitoring requirements of permit.
<br />5. En[_r "S.u;p/e nie^sur~,aent"dales for each parameter under "~u~;rti!y"and ~r1!ohh'' as specified in n_:mit. "Averosfie"is
<br />non-,ally a_ ithmetic average (geor-~cL-ic eserage for bac~erial ;:.ra,rcles) of all sa*~plz ~neasucemcns fcl each parome:er
<br />^baincd 3vring ",~t;nir;ri.tg Pdri .%". ".:Lairra~re" and ali,ri rrrul" are n!,rmally c.,trc'nc high and lcw mcasur~trcnL~
<br />cb~c;rrv~d d' -irg '.. "•.:rit,rirvF P•, i• a". (TJoic In muric ;'als wi!'1 scconc.m~ tr,•,atm_~n( r~:quircmett: 'riLr 30-day ave;~g.
<br />of sa uple mcasircments under "fi;:'tlJas,"ard enter ma;in:wn 7-icy aver`oe of simple mcsurem,:nu obtained dmirj;
<br />monitoring period tmdcr "iv%trirnw]I.")
<br />6. rn:_r "Fere.ril H..; "fir. •nt" far eacit parameter ;md_r "z;;",,,i,;'"t~% "[finality"as sptc~~i;.d in pc'7n~'..
<br />7. i;nd:r "i~'o F_'" epic; num>>er of sumpk mcas~cm: t: ~~.ria,g mo',~tu - rg ~ :r cd ~ : ~:.xrd may i„i r- (andh r rni,~`' -un,
<br />or 7tay a.,.rzbc as appIo ,late) nc~;t rcquir~_~;,cnt roe cacl•~ Ttieramct~ , tf none, cnt=: ' 0 ".
<br />8. .'.r.~cr "Fr,,.rr-,~. cji,l_/rsis"both s ".S_o;r; rJ ,;r~'r~cr~,at.. (ec:ul f-c_,._,r c; s:. -fin, .~S a: a;sis ,iscd Gar"
<br />monitnrng pefor:) ^nd as"/'_,~,lit /Ze~ri.vm_I:%"spc~if:ed in pe:~ril. (_,;, C ,far "~ .:r "fcr cneiinios r. oni:~r,i,ig, '7i7"
<br />;or art is y per :~•e~'~, "//30" io: one day per munL'i, "/.'70" ful are day per quart,;, c:c.)
<br />^. >;ma ",5.~,,. ~r_ T "bath "~ ' _
<br />t . }T-' a< -:FL . ; _•su a;l: . ° (actual ;.aa,p~c lyp: !,s-cd dry, ~.,;; rioc'.onn~ penod; un~' as "1'.~, r.l%.
<br />R.:,Irirzr~t~at." (e.o. ~-,i_r "Crv1-" fo* i~:ditidur,l saruplr, "_'dr?~" `or 24-hou ccmpcsitc, ';~'/,;" for con.inucus
<br />monitorng, etc.)
<br />I0. >-:/her,` viol:' ons ofpc*mil requirements mu reported, attach a u;icf csplaca!i~n to dcsmbe cause tad co:-rec;ive a; iioa
<br />to be U.ken, and reference each violation by dale.
<br />i l.:r" .o discharge" nccurs du-irtg moniwring period, outer "i•lo liacilarg.:" across fora in pL1cc oCda~~ end}.
<br />12. ante: 'S1to,a:/Tit1s ajFrinciF~! Fs~_11live Gjfi.:_r" with 'Siyn~tura ,Jl'rin.i/~! Csa~ud'.•_ Gfji..•,- ojlut;!s,~izdJ
<br />Agsnt. ""TelrFhsn~• h;ImFrr,"and 'Doti" at bottom of form.
<br />13. '~lafl signed 2eport to Cffice(s) by date(s) specified in permit. Reiain copy Cur your reconls.
<br />]w. Uore dctailad instructions for use of this Gis~lurbe hl~nirorind IZport (Gb,72J form may be obtained Crom Office(s)
<br />specified in permit.
<br />Legal Notice
<br />T7tis 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 in
<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 year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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