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~a~erw~r~ ~~~~~€c~~`~n Act Notice
<br />°ublic reporting burden for this collection of information is estimated to vary from a range of ] 0 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 />I 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, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed a[ entry of that information already
<br />preprinted.
<br />2. Enter "Parmiltee Nomz/Mailing Address (and facility name!location, if difFerent)," "Permit Numher," and "Pisch~rg„
<br />NumFar" where indicated. (A sepaza[c form is required for each dischazge.)
<br />3. Enter dates beginning and editing ",1'lonilcz•ing Pericl"covered by farm where indicated.
<br />4~. Enter each "F1ram~ tzr" as specified in monitoring requirements of permit.
<br />S. Enter "S.rmrl ~ b7-- rsurznrent" data for each pazamcter under "Qzz n!iry" and Quality" as specified in permit. "Av~rae r" is
<br />^ormally arithmetic average (geometric average for bacterial parameters) ofxll son plc measurements For each parameter
<br />obtained during "L/,nilorizro Period'; ";vllsinsnn" and i~/i,%i;,nan" arc nornally czhcme hig~ and lo~~~ measuremcnie
<br />obiaircd durng ",LI•.ait•„ ing Period". (Note to municipals ,^ith secondary Iroctmei•t requirement: L-n!cr 30-day avnrgr
<br />of s?mple measu.remcats under "Ava,-lo:,"and cuter nLleimu:n 7-dey e.vc.age of ezmple measurements obtained d~~rn•g
<br />monitoring period under 'SL1~zrimmn.")
<br />6. '=n.e~ "Pen,zir R~ 1uir rr,;enf"far cacti parameter :.,,der ";.~~1nu~~~"2nd "Quu!i l)~"as specified in pcnnit.
<br />7. lineier "iJ. fir" c tr- numi;er oFsample m_zti~~cr.:„t dsr'ng monitoring period tlr:: ~r,ceed mazirncm (2nd/cr mioin-um
<br />or 7-0ny sc-rage zs appropriate) permit rcquiranent for each partmetcr. If none, eatz r "U".
<br />S. -. ._ "Frr;~z<•,~_3 cfiurvly~i~"bath as "S.,^•; !J S!__n:~, :,nt,~r" (actual fcqucncy of sam~lu,~ sod an.u,~is used du~u,g
<br />mnr.~,or;eg peziod) srd as "P~,-,.,i! Rey„i,_nuni"spccii5cd in pe.nnit. (c.g. ~or~: "`~„~1,"fr,rcon:L,uo~.~s rryniinr'r~g, "I /7"
<br />For one day ~, crecl~ "//30" io-one day pc: month, "!.%90"for one day per quar:c., c_c.)
<br />5. %n~~d "JJm !p 7•r '"'~nih P.5 "S/~i. 11 ii'_~r.'.•-dni'1,:" .CtLlfll S~m i. l~ Lg:d dLLrlnr~ TrJniiOrln~ n:riod r,nd ~, "P~]'id~i
<br />fC:.lr•%r,:,n•.;f," (e.g. :?oar "Grai•" for :ndrviduc' sampic, "~4!i~" roc 2~-heu* composite, ",i%i:" far eon•inueu:
<br />monitoring, etc.)
<br />10. t.75erc vrolations of pcnnit :equi:cments an reparic d, attach r bref expleoaticn to :escribe cause and corec:ive a~llon~
<br />to be 4.ken, and reference each violation by date.
<br />1 1. "nu discharge" occurs do~og monitoring period, enter "Ne Dscharge" across form in place of data entry.
<br />l2. ~n:e: "iJ~raJTilL rj Princi/.~! F..ce~ulict Geer" with `Si,~nsntre , j Frin_i/ ~! F_~se_7ni,'e G~,T •er of Au!'ro, hsd
<br />Ah.:n/, ""Tales 5;n.; Nzunher, "and "!?~(e" at bottom of form.
<br />13. Rail signed Repoli to Office(s) by dtte(s) specified in permit. Retain copy for your record,.
<br />;viors detailed instructions for use of [his Disclrurge ~Lf,ni!r„dog 2Psr7 (G,L:R) fora may be obtained ;rom O~cc(s)
<br />specified in pcnnit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 131 S; 40 C.F.R. 125.2Tj. Failtue 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 year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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