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Paperwork ~~uct~~n Act Notice
<br />Public repot'iing burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per respanse for some minor facilities, to 110 hours as an average pc. response for some sajor
<br />facilities, vrith a weighted average for major and minor facilities of ] 8 hoes per response, including time for
<br />~ 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, Informatio^ 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 "Pzrmittez Name/dluiling A~irzss (and facility name location, if different)," "Permit NumEer;' and "Giso•/turgz
<br />A!umh: r" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "dbnitorir:g Perin-i"covered by form where indicated.
<br />4. Enter each "Poramerar" as specified in monitoring requirements of permit.
<br />5. Ent.:r "Slrr~l_ .'.1_,tsuran'n!" data for each panuneter under "~:!antity"and rulliq~"as specified in permit. "Araroor" is
<br />^or-nally arithmetic avc ~gc (geometric average for bacterial paramc`.ers) of all s:urple measurements f or each pa~zmeicr
<br />obtained d~nino "Af.nih.rino FaicJ'; ":ii~iinunn" and mfi,rivuun" are normally c~tremc high and low measm'`mcnts
<br />cbm:¢ed diving ".tl.nit-„ in,{ Pdri ,!". (Fete lu m~nicinah ~~ith secondary Irca.menf reyuiremcnt: F.ntcr 30-dLy avr:agc
<br />n. s: ~nplc rt:casl:'emcnls unc;cr "NV=,vea, nu carer maximum 7-dal average of smnp'c mcasuemenu obtained d uu~g
<br />monitaringpcnod under'SLluvnrum.")
<br />6. rrr_,:: ''Pni,.ir iii•;tfir_rnsr+t"fat eac:r param:tcrunder "~u~rr!iN"and "~uulity"acsp:;ci ied in ;;crm'_.
<br />Z Under "••!- . " e;,,.. nor iLn c,"sample m.::nr.re,- ^rt: ci~irin~ monitorng pc;ind thrd c,.caud maximum (and/or mir'rn~n
<br />or 7-cay av~:agc as appropri::c) permit r.yui-er^cnt fi,r each perimeter. If ¢une, eo'~r "0".
<br />7. -n?~. "P'r~, •,: j. ,.f.',r,:,j.,e?s"L•¢i~~ „ 'S.n„~1, ,,,_n.,ar,u..."(u_Irzl i}c.{u•-ncy ui 5~-~p'ing and anal"xis :~scd ~u~n;;
<br />rr..ram`ng p3ioc) arL cs "/'~n,ri! R,_t,,!,v,n -,~r" spxificd m ,,~ ;:,~~. (cg. l:nte; "Con!, ° forcont~nuo.rs mn¢iwring, "//7"
<br />Car une cay ,-.er c. ec4, "l/.'0" iur ouc dnl• pe: rnt7 r.!1t, "i!90"for une dsy per qu:.r :cr, c's.)
<br />,. ~~,_: 5ufrt-!a T ~~_"L•cth ar. ~„rj is .. __ ~ .•.nu.:: (a!•h~c~ :cuplc typ_• uszl du~•og r~.rndoring p^~cd'~ anc as ",~sr„~;.
<br />Rair•ir.;.a.~.'," (0.o. F.~ltCr "v/'1I-" fo, ;ndivid~.!.! s:unplc, '7471" foC 2~~hou: co~npusitc, "i5~~~" ~Or COnliPl!6¢5
<br />monitoring, etc.)
<br />~. ~~Rli GC V701Li~OnS Of ~.".-f711[ :C(tL• -l:mfR15 LrC rCpnriCd, attach a br..:f cr:planatitn to cescribe cause r.nc currech`rc ,retinas
<br />to be taken, and reference cacti violation by date.
<br />I I. I. "¢~ discharge" acvrs d_,~ng uionitenn~ period, =ni:r'T;o Gscharge" across fonri in place of data en(:-y.
<br />12. Gn:er "iVu,rra/Ti!l8 of i rincd~u! F:r;.u!ir: r/~_-_•r" with "S(gnuiur,: ~,f Frir:_i/\~r F_.c_uttiw O,ji~rr of /uibo;~i_.:d
<br />Abcnr,""Telap;aaa NumPsr,"and "Cora" at bottom of Corm.
<br />13. l,a[] signed Report to OfSce(s) by date(s) specified in pcrnut. Retain copy for your records.
<br />14, iviore derailed instructions far use of ;his Disehurt;z ivl,rtirorirtK RaF~rt (D.i~ Conn may he obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />Tkus 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 far not more than one yeaz, or bath.
<br />EPA Form 3320-1 (Rev. 03/99)
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