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~a~erwork Re~~,~ctioo. Act Notice
<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 hours as an average per response for some major
<br />facilities, r~ith a weighted average for major and minor facilities of 18 hours per response, including time for
<br />~ reviewing instructions, seazching 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 />Washingto a, 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 directed at entry of that information akeady
<br />prepr-in'ed.
<br />2. Enter "Pznniuea Nam:/Mailing kddress (and facility name location, if different)," "Perini! Number;" and "Disrh~raa
<br />Nurafar" where indicated. (A separate form is required for each dischazge.)
<br />3. inter dates beginning and editing "ivfonilorirrg Pzrirf"covered by form where indicated.
<br />4. F.n[er eactr "Farauret_r" as specified in monitoring requirements of permit.
<br />5. °.n;e- "S.~,nph: i.I ~asur~ro;?u"data fer etch pammelcr under "~narei/;~"and Qu,~l%t)~":LS specified in pErtnit. 'Ar~rv~e" is
<br />r o mr'I;~ ariCrmetic ~•,rerabc (,^,;:~metric zvcrage .or bacterzl panmeten) of all seml~lc messuremcas for cash p~rnme+_r
<br />al-.taMe:; during "li-.nivriao fari',.(", ";.i ici,nrnn" cd ;diniie uu" arc ncm•al',y e:a _ine higl- and low mczsu ~; rods
<br />^bL~ircd do~in;; "~d~,u;:.~-irrd F;;r.l". (1Colc to mu~-~icifal~ ki!'i :'.ccandary trcah;~cnt ~~ciu;rcn;cil: °,tcr ;0-day avcra~-
<br />^f r ;nrtc ,ne:+r•rcmc,ts under "fiv~r.ro_ "az~d Enter :nExir,,un 7-day cvcrage cf..<.cm,ta meas.*omeats obl2tncd c.u_i
<br />mc~ritoring period under "iri,uir;tuin.")
<br />b. ~.a .'r "~ ', .. ;l!(£~?1.SU7:. t" ~L, E&C~l17ai.7r'1EiEr LTdE '.y~~i, r.:7"Fn_ "Yht:.lii;~";.c 5~-.ci~icd in pe-nit.
<br />7. .iricr "i'-. Cr" con . nwa~cr ufssn~le m.,.,arEm.•nt d~ Grp n•.nr;,r.,;i~Z ;:_~a'..:' c.E_~_d ^~n:.fn-um (and,'or min'rw~,
<br />c, " :~:} accr~~J ,., ~;~proprirte) ycrmit ree~ir.menl for Each Para-~cter. tf aonr., erw- "C".
<br />C. _.:,c; "r•,-, _ ~~' ... ~h ~%~"L•ce'i as' .. ,~'• .,,, „~~;. „_., ' (ecl:al ~„m.~crr.; r'.;ml•!ir.~ a. d znai; sis .scr d.~ri*^
<br />mo:~•GOr~n~~p;;'ad),nc:as"Per„rirR~;nir:,;;_u~"spcci~adin.7inni' (~~.„ ~ctr.~'•-,,.r~r."~~ircun_.i:ousrnnnii~~:~:g,"1/%"
<br />;ur one J;., p.r,r~i'r, "1/30" far ono day n;;r m,mt',, "1/9CJ" for cne day per qum7c-, e~.: )
<br />~. G^.:. "3 era; t, T;;-_ ' I:edr ss "S -,arL• ,.: •.., rr.;:, r" (tciual ,, n.plc h,3~c used dunn~ mun''or.n;; oericd) ar.d as 'f ~ z~i:
<br />h•rr~~z.:a r" (e.g. l;nter "Grin-" fog i~,c'ir'iduat tErao;., "?~/': fn' 24'iar composite, !?ii"' `ur can'irco.~s
<br />monitorng, etc.)
<br />10. ~;!ircrJ ~ielatiuns of ~cmrit requirc~ncnts er: icnG icd, aita,'r u 1 ~icf ezplan~tion Yo do tribe cause and ccr;x:ivc acricas
<br />to b: ;a'cen, and reference each violation by date.
<br />1. 1. "rn d;schcry;" o•:cur, dr~ny mon;:orin;; p_riod, cnt_r "No Discharge" :.cross form in nlcce o. ti:aa e~+n,.
<br />1?.. 'in:cr ",Varrz/Ti[l. %f lria.il.al r. e uriv, G~~ _. ' ,t•ith "Sidnalurz of lrr,r.:yil J.'.r~~-t•tic~ G~ ~~r aj ~;r•!;r .-,:el
<br />i g~nr, ""T •Ir~nr nr~ Thun!-tr, "and "C:at.~" at bottom of form.
<br />13. ?.4e~i sig red Report to Offire(s) by date(s) specified in permit. Retain copy foryour rcords.
<br />14. Yiorc detailed instructions for use of 8'.is Cis~lurg<< N'~.nito;~rr~ RzF'~rt (IJivrR) form may be obtained from O ?ia:(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 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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