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Paperworl~ ~~~~~:ron Act Notice;
<br />Public reporting burden for this collection of information is estimated to vary from a range of ]0 hours as an l
<br />average per response for some minor facilities, to 1 ]0 hours as an zverage 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 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 i
<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 />~e~aeral ~~astructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted
<br />2. Enter "Pe,•miuee Name/irlailin~ Address (and facility name/location, if different)," " Par-mit Number," and "Cisdiarge
<br />Numhrr" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "M~uiroriug Period" covered by form where indicated.
<br />4. Enter each "~oramaer" as specified in monitoring requirements of permit.
<br />5. Enter "S~+rtFI,: ,t: ~.aur~meet"data for each parameter under "Qnanli7~" ard'~ulliq~" as specified in pc+miL "Av_~r~$o"is
<br />ur;ntlly arithmet;t average (gcorociric average fur'cacterial parameters) of 211 sar,plc measwfmcrts fnr each parome,cr
<br />obtained dl ring ",LL' uil•.ri•rg r~,7/~d";/r'~Y~rh.c:i+;nrn+" rid ivliniu+um" are normally ~~UCrnc high end '.u,+, measuraecnts
<br />Ob1i i1'f:i duRng "m ~.r7~1'd'i,id P_'1"i i.l°. \•`OiC lu 17~I1r ~CP]aI5 ~'I_!1 52l CIli ~P' 1rCB(mCni I'~. ~'W-Cm!';'!: I'C1L" 3~-day CVtra~C
<br />of ,cnp':; ,n..^suremoris under "l'~ 1r1~ ."and erdcr :s.:-u~ 7 d:,y .van;;c c"s:,m,, ;: mua~.ur.rncn~ obtained dying
<br />monitoring period under ";/;,uirunu.")
<br />n. °n''rr"r,',~.nirk.:.-vi,-~ma~r"c'eachparar~:c:er:order",'..)i_orlir~.'"an•J"_..'i;'"~.spzdfredFtpz~ri:.
<br />7. U~'. ~ "i,''. E,." rntcr rumbc of s mplc m_;:.u,~mcn: ,~ri~IL h c ': ~ gin;, ._r .,c ~'~ ~ .:cc_'d rlu, morn (eu,ur m~~r nom
<br />cr 7-d:y avers;,,: rs r~nrcpri~t~) +:crmit n;c~uir~mcnt f...sh paiamcl.r. !~f nrr o, ,:o,,....•/1.,.
<br />,,. Pia_ "F,~_,,i,.:+ ;, -j .,. ,r,,•~; 't~cN~ as r. ~.. r.r„ .. .,'!"(,~cn,~ ~ .~u~ -.c•' c` ,,. -;yin}; anJ a iclysis ,scd i urine
<br />'nuni'ol. i~ pr~;od) n~,d cs~"r1•.-,.~i~ R=/erir~,,.a !",~cCiFid ~ii .rt~, 'a.~ !..ae. u1 " ~~'r cun!:~ucs ~ ,nircrin~ "117.'
<br />fe: one dny p_ r ~c~e'.<, "!/30" for me day r.cr me,r'~, "; /90" firr ur + dr`y per qu; n , c; _.)
<br />.. Fn~rr "S_a; !, T. i:nfn as "~: + i_' .~., :,,~ ru,: -t.:J sum lu D •c _:~d Cl,r. ;~' ~.~,i[oring a.nc~ anu: as ", ,„n•:
<br />~'~r~%%~.a.n." (e.g. ;-..I~cr "G,vr" fur FuJ.F,~r:.i~~l :a:rf ".~,n'"_ fur Z4-`.0:.~ c!vr,pusi,c .:'f" .ur curnun:s
<br />monitoring, etc.)
<br />IC. S'`:er viulrtio,r of ncnnil reyuiremcntt ere ro;~cti,l, attach ~ hric~ ~.rrl, na„r~•~ c u: c~ib~ cau~~ any car;c.n~c ec'.iu~s
<br />to he taken, and reference each vioiatio^ by date.
<br />t t. I""ne dischrrl;c" occurs dur;ng mwti'o~ing period., cu!.r "~'o'~i~cl~nrg~" runs Lmn ~n place nfCat~ entry.
<br />12. 'later 'S`.'_',ndiill~ uJ ,°ri,re,•il-1! b're ~rlir. L~j .. ' t:'i?h "5:5~'~ICr~ rf 1'r%~. i~.r' L'sd_74ir: .Li_e ,j Av+lr,rc_d
<br />AKau,""T~lap5at:lhrenhsr,"and "Ca(,:"ztbottomofform.
<br />13. Mail signed Report to Cflice(s) by daW(s) specified in parmit..Rcrain copy fur your records.
<br />14. More detailed instructions For tune of this I:is_•ha,~s ,'v;',nh.rinb Rer',-t (C/~lT/ furs may be chaired frern Office(s)
<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 no[ 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 £or not more thaw one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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