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I'a~ervvork ~~~~x~~:ion Act Noticw
<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 boors as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of i 8 hours 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, 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 />]. If form has been partially completed by preprinting, disregard instruction dvccted at entry of that information already
<br />Preprinted.
<br />2. Enter "Parmittae Name/Mailing Adirzss (and facility name/location, if different);' " Pzrmit Number," and "Dischargz
<br />Nronb2r" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing ",Vfoni[oring Pericl" covered by form where indicated.
<br />4. Ea".er each "Paramrt~r" as specified in monitoring requirements of permit.
<br />5. toter "Smu~l.c ,Ll. ocaramtnt" dat: for each parameter under "~narniry" and ,;nraliry~" es specified in permit "Avdrags" is
<br />normally aritl-,metic average (geometric avcrge for hactcrial parameters} of all szmplc mcasuremens for each pammctcr
<br />o'tained during ".L!-nir:rin~ !'~;i~„/'; "^~Ia:imnm" rod dlininuon" are normally r:cl:c;nc high and low mcasuromcnt~:
<br />obte;ncd dutirg ';l'.,~i7 .ri:rh F.•, i :1". (TCeL: to municipals with scamdaq+ trca'.ncN rcruireme it: T-Inter 30-cLry ave ~~c
<br />Of 5. -~p~t: r:1CLi11rG i1C~L5 Cr _7r ",4 v,~ao_, c~ d enter m,-xirun ~]-day aVCragC ei SE mi~tC mCLSLfCnIcnS obtnlned d:1N 1;
<br />monitoring period under "rLfasinuun.")
<br />... 3n'.cr ':".',9,a%t R - n+i, ~m ~,:r"..°ar each parameCer undo- "~;.~nlth,~"and "~iu~li;~" as sncci i~,l in pa~it.
<br />7. :;nd-r "iv',r %-z' en~_r nun;b:r of s, r+plc m%sir~mc: + c.:rsg roz _~.i rg -,.; ioc' :: . e::cc::d mar.~n,rn (xrd'cr min~arim
<br />cr 7-d<y : v.-ar,c os ; ;~i,rupriatc) ; ;;mit tuyuirrment 'or each n:.ramc r. t(nmo, enter "n"
<br />^,. -c;cr "!-rz, ., •j .".r~!'re'~' yn?-, a~ "~ r:,,-L iv,~r~ . _, ~„ ., ' (;:c;uzt couerr,. n` sc^i:aing cni anal ~ s ~
<br />r. t use c c~ir:~
<br />moal~r 3' .ioE) a.,' as "~'~_.,,rit R:;mir::ar'at"lpeeificd in pr,nn~'. (ag- i.^LL ":o;,"fercarL~m:n~is ~r:;nilurir;;, "!/7„
<br />fc.r ore de:y ;c•.:.c':, "//30" For one day ;:ei murd~+. "I'90" far or.c day per qu:.r'e;, e'c.)
<br />S. _r._. ".5,,;{-r- Tj7-_ 'Sofa zs "Sa;aTl~ ;:.' .err:, „ _;+r" {:: rya' s.:~T,p',e type u,:d dvirg n onito~ng ncnoc) : nc; s `T"•i,r:1
<br />R,cy•i~~~,;ra.•" (c.g. :=.nta "Gruff" fo+' individual scma'_, "?4;;~" fur ?~,hc.,_~ ce:npusiu:, ';'t.%(" fur coe'isucus
<br />monitoring, eta;.)
<br />1C. l;rx~c violctions er; cTit ranrirem_nts ac repo^.ci, nttlcS a bricfcxnlanc+io~ Co describe cau,c and ecrcc ivc sc:fons
<br />to ue taken, rod reference each violation by date.
<br />11..r"..n dischrsgc" occur daring monitoring, pcriod_ entry "Nn Disrharec" across form in pluec ofda,e entry,
<br />]2. ca.er 'n'aru/TitL of Ii^n.ri~a! lt~cvtn • n~,.~.' with "Si~~rJUrr~ cf Frirc it u' /_Y~cutirs .'i/5ca,' of tin!1•-•.i :~/
<br />f(hart, ""T~lerln,rs Ahurah~r,"and °Gdl~"at bottom of form.
<br />]3. Mail signed >Zeport to Office(s) by date(s) specified in pcrnit. Retain copy for your records.
<br />14. More detailed instructions rot use of this Gicc;rarbc ri<•.nitorinb R_/srt (C A•IR) fens may be obtained fmn Offca(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by faw (33 U.S.C. 1318; 40 C.P.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 yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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