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~a~erwork ~~L~~xc~ on Act Notic
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 Moats 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 I S Uours 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 buden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washingto:~, 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 duectcd at entry of that information aUeady
<br />preprinted.
<br />2. Enter "Permittee Name/IL1ailing A~drars (and facility name location, if different)," " Permit N'vnrher," and "Discharga
<br />NurrL•ar" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "M~;ritorirrg Periol" covered by form where indicated.
<br />4. Enter cash "Prn•amrtar" as specified in monitoring requirements of permit.
<br />5. Enicr ".iJln~/e /1'%l.Pr!/YINdnI" data for each parameter uadcr "[ittmrrit;•"and ~ualit)~" as specified in permit. 'Artr.+s=" is
<br />normally arifrmct'c average (geometric average ror bacterial parameters) of all samiJe measurema~.[s for each par,mcter
<br />obtaincll dur.n~ ",1/.rri%.riq; /'ari ;N'; "lv;_.riu:um" ar. i.Ii,ti .ana" aro no: mall; c;ar:me high and Imt measuz :'cats
<br />obtained dutirg "~b, .rti; :•ri,:~ F,a:i~.l". (Note to muc':ipals kith sccondar}~ trea'mc i; r. c,ui:rmc tt: Lnter 30-i;a}' a<<,.~~
<br />of sa^; 1e c~esnrcre,}s ur:'er "tiva Wis.,"and ca'.cr c.rxim:~; 7-day average of sin,;:'.c mcst rcrren LS oLti incd iur'; L
<br />monitoring period under "Pdaxilnur.r.")
<br />6. i'nfei "/;.'iu,il l~' fni,'dil ';:/" far cr'.c;l pardroeter undo- "~.e.,-r%Ip° ti:;; "i!!7hryn a5 fip: Cl~Ed 7n r.'.Ol1iL
<br />7. I;ndcr "i:'~ lir' enter nunbar of samrae mcasuremen± ~'e~~ng ~rrn r~ ;~g y.:~od t'iz! ..cc.d ma>.i~r.ua (and or m a r.am
<br />cr 7 day aveng:: as anprooratej ncrmit re~uir ~mcnt for each prnmcter. If none, e~tcr "0".
<br />tt, i~ri',~r ~~/ r_; ':.h ~~ 'f: ;11.1)'515"beth a5 ".S_;, qc;•• 1 ~;'. c~•.'.'„~.'.~~" (a Cil]'ut i~fl'L l1 Cr C~ Of >ar,'If.im~ aC i{ FL~2I~B1S :5Ed GC'rli(~
<br />ma.i:oring ^cr:oc:) ;'.~:: as "P',.:Iit 17,:;lli,Y;a:,;r" s-pcei~~~d .n r. rmi' (e.g. ~~:rte. '..:,a;,"for cc ~ ~:au~s rr~nitcf„ ~ "1/7"
<br />fcr one day pc~ v/ce:;, "!/30" for nae day per r.on"r, "1/90"for ore day per qu.l~ :~ , u•_ j
<br />9. _r.'ar "°~nr; /; TIr3"both as "Sa,nrls ,;^°.~,rr, _;, -,rt" (actual samp'c 4Pc ,scd during rno,ritorin~ n,r;odl and ss '! ~,-„r;~
<br />Ryuir_•rrrrrr," (e.g. ':rater "Grol " for udiridual szmp:~, "~~'//:' fcr 24-' a~'r cmrposite, "A'SS" `or co:-[im:eus
<br />monitoring, etc.)
<br />10. C.^rere tinlatio~s of permit requiremcn*s arc :Lnorei, attach a b-icF e ~planatio r Lo describe cause and core: Cvc act`cns
<br />to he taken, sod reference each violation by date.
<br />' 1. ii "~o dischzrge" cccurs during monitoring pcrind_ error "No L`ischar,^r" across form i:r placo ofdata entry.
<br />] 2. Cn[er ",\ramzJTiti~ of Frinciraf F_rz.:utn'a C/~ ~ ~r" with "Sitirvtw:• of Fr in _'i/ ;t ,°r~ °uriv.: (Jfli~e.- of tiurhorizz~l
<br />Agent, "''Tzle~G-.r. s Nu.nhrr, "and "Doti " at bottom of form.
<br />13. Mail signed Re~rort to OtTce(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Gie~harba N,%nitosing RzF err (G.tdFe) form may be obL~ined frcr~~ OFGc:(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is requred by law (33 U.S.C. 1318; 40 C.F.R. ]25.27). Failure to report or failure to report trvthfu:ly 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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