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~'a~:~r~~or~~ ~~~~~~:pog1 Act Notice <br />Public reporting burden for this collection of information is estimated to vary rrom a range of IC hours as an <br />average per response for some minor facilities, to 110 hours as an zveragc per response for some major <br />facilities, with z weighted average for major and minor facilities of 18 hours per response, inclining time for <br />reviewing instructions, searching existing data sources, gathering and maintaiaing the data ~Zeeded, and <br />complctiag and reviewing the collection of inforration, including suggestion for reducing this burden, to <br />Chief, Information Policy Brandt, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W. <br />Washington, DC 20460; and to the Otlice of Information and Regulatory Affairs, Office of Management and <br />Budget, Washington, DC 20503. <br />General Instructions <br />1. If form bas been partially completed by preprinting, disregard instruction directed at entry of that information aUeady <br />Preprinted. <br />2. Enter "Per-mitrzz NmneGLfuiling Hddrzss (and facility name/location, if different)," "Permit Numl-er," aad "Discharge <br />NunrF~r" where indicated. (A sepazate form is required for each dischazge.) <br />3. Enter dates begimting and editing "ionitoring Pzriod" covered by form where indicated. <br />4. Enter each "F'urame[.~r" as specified in monitoring requirements of permit. <br />5. :rater "S.nnpl,~ r191~.cru trnent"datz for each parameter under ''L UUntiry"and ~nralitj~" as specified in permih. Av.r~~a"is <br />nog malty arif,mctic average (gcnmettic average for bacteria] parameters) of all samplr. measuremcnu for each parameter <br />nbtaincd dur~og ".V,rril;ri,ro R~ri~d"; "l~karirnunr" and blirrinvr.r" arc no,-rrally e, Ycme big!-. and 'o,! mcasu-c rents <br />ohtaincd dwin~ "~.~,nifsriub F,:r-io!". (1:ntc ro rrunici~uls ,, i'tt secordap' treatment ~;u cement: linter 30-day average <br />o.°~antnlc rncnsurcmenls vsCer '~iv~r~rSz,"and enter 1:,; <ir,turr 7-dty avera,~,e cf sera~•~Ic mezar rcmenLs nblaincd r_u: ^g <br />monitoring period under "ivlasimum.") <br />b. rn''~~r"F,-,nirl7t~rtiran'„t"'oreachparmcierundr ":,u.r:: tu; "~u;eliry"as:.r_ci~icdinp,:-~ni:. <br />7. J `,iu "i '„ E.;" ante r•umbor o. sama!e me4c~ur:raen! ;lining rr,o-.~h,ing p_r.nc"~~t c..cx:; n,~ar.'mer. (av~n^ -tic 'urn <br />or ~-d:.)~ uva ~gc as 2oproptiatc) ycnnit rcq~,dr_men[ f ~ir etch parumeter. If none, enter "~. . <br />8. =.aer "F,,-,r~::,_, ,fa,rll)s;,•' bu.~• :.. .,_:..,:.'' '.: Flu _. ,:ar" (acta.a Rc;;ue,-c/ c" sc:rpliag a~,d a-,c'ysis used dwrng <br />mnnitorng peroc:) end as "~ •n,ri, R~;`uir: ur ~r,r" sp[ciG:d in ;,cnni' (,:.L. (•6:: "~,„u." list' con. nuoun a onihaing, "iii' <br />f:~r one I1y pe: v;~e!c, "1/3~" fur one day per month, "fi90"for are day p;,r querir.~, etc.) <br />9. Ent-, "S'.ra; L• Tj~•d" bu:~t as "5.,,,r~ Ir ;i'_.e~r•°..,tr-" (:.rL~l s.mtplc type ~s_d dur.~;; r-,un~foring ~ctinrl) amp a. ' r ..i.,;, <br />k•./rirrarar{" (ag. ?n!cr "Gr1i" fu^ itditid,cl .:,tp'.:. "?dU:" ;or 2d-hour cumpotiite, "~\'/~:" for ce..ircc,~s <br />monitoring, etc.) <br />10. \'!`~erc violations of permit ,-cquiramcn;c ar ropc::e, ~Itach a I ~ic'ez-~I.nn~;on to d„ .a the cau.e and cccre:!ve a%~aas <br />to bo taken, and reference each violation by date. <br />] 1. li "nu disciierge" nc:curs during monitotin); period, Cr,tdr "~~o IJisihargz" actues form in piece of cL•!IS entry. <br />1_'. =n:er ",\ramJTi!!~ of F,-i;r,;irar r:_•..utir~ :,(? . wi!h "S'i~,r~lura cf f7in_i~i! Esaartivz (j`i.:~;~ of i:ulh~„iz:,l <br />Agent, ""T•lep6on.: NumEe.:"and "Cale"at bottom of farm. <br />] 3. ,Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records. <br />14. Mnrc detailed instructions for use of this Cisclrarbe :Lforitor:brs R_F•.r7 (D,b/R) form may be obtained from Ofrce(ti) <br />specified in permit. <br />Legal Notice <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 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 titan one yeaz, or both. <br />EPA Form 3320-1 (Rev. 03/99) <br />