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Paperwork ~e€luction tact Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 1 C hours 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 18 hours per response, inc]uding time for
<br />reviewing instructions, searching existing data sources, gathering and maintaining the data n~cded, 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. Envirotunental Protection Agency, ~O1 M Street, S.VJ.
<br />Washington, DC 20460; and to the Off ce of Information and Regulatoq~ 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 already
<br />preprinted.
<br />2. Enter "Permittee Nama/lvlai/ing Ad~Jress (and facility name/location, if different)," "Permit Nnmher," and "Dis~h~rg,:
<br />NurrrL-er" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Mcrrita-ine Pu i.;1"covered by form where indicated.
<br />4. Enter cac'u "foram°ter-" as specified in monitoring requirements of permit.
<br />5. L•nt_: "Sample N, ~asurr+,r ant" cLaa. for each parameter raider "(~++ mlirv" and ~+u/i/~~" as speci fled in permit. "Ar~:~:'as ~" is
<br />ronnally ariPtmctic average (geumctlic average far bactc>;al parameters) of all .an,pl~ mcasurmcn.s fnr each paramct. r
<br />obtained dwing "V~.nir•„Lr~; /:•+i-,1'; ",h1_riua+,a" end ,S1i.~in;un," a-~ no~mnlly _;Irme higl- rnd !ov mcasu-emert,
<br />obtained during "M•.aih„-i,:h f.•n.1" (":ufo fi muc'cij•als with sceucdar' trtatmen, r~,u:rnnc-t: 'inx 30-day a~~ragc
<br />of sample measurements un ~'cr ".,r_r~~ ~,"a-.d tenter mc:cin•'a,r 7-u ay aecragc et so t ~:. mcr_srrcr, eels ohti ind d]rir.t,
<br />monitoring period under "i»„crinuuu.")
<br />6. _. _. ": _•;ri: Rr;,r^';-~;;r_.,r"''o-~clt parmcf.r anc__'L;u, li'!~" &os '•Lhr.i/ire" ai specified in pcl ~ t.
<br />7. Under ",^.': J•,+." cuter nombor of sa'-''.e n:acurcntent a. ring I .o •"raring ,.=god " ~. _ .c~cd ma;.~mnm (;,nrlior min~nmr
<br />or 7-der, avert„ as :.ppropriate) pc-m~t rcq,: rc,ncal frr r ::h ,:ur.'.metL". If ~onc, cn!c. "i%'.
<br />G. ?ntr "Fr': ca=n ~"~`..;~~h•sie" hot` cc ''S.. ,;~! a;. _... _.. , ." (ncWil ,`-cruel c; ." c_,rlplinl; :d n,l~l; si: usei ~.rir~,
<br />monitnring ncr od) : red as "l' •,,,;ir R. ;m;; em_ur" socc'r.~d in :ern it. (c,g, C-t. r ' .•.: r!, " li n cm:;L r!e: s monilurir„ "I/7"
<br />fer erne day p~ '.'red;, "!/?0` far ene day per mortis, ^/,r0"fnr one day rer quart..-, eicl
<br />9. ~n•er '.":~r,yL T;y_"L-ot.. ~_ ".SJUi-I..i,~,.:.^ t,,.-,r'" (rrtw:l s^" oic h/i.e u~~d : ~~•t~ maniac n period) and as "`rn;r
<br />F~•iui,-,:ot~rt," (erg. =ntcrf"G,-~t" far i;d,~idual r..:rnple, "?s';!~" fer 24-'0 ~ composite, "\'; ;" for cor,'inucu.
<br />monitoring, etc.)
<br />!0. !'r^,t~•~° ~•ioleticns cf perm rcgciremen's ar• ;c~or!ed, etiacu a 1: ic~cxpl~r-itiun to d.:..c~ibc cause and cur:,;~tivc actions
<br />to be taken, and reference each violation by date.
<br />11. If "no discharge" occurs durir:g monitoring pcriol toter "Vo Discaargr" aces; fo-m in p%c, cf Ja,e e,ary.
<br />12. Entc,- ",J~m:JTrIL rf frincirri £.r_..zr/iti:° Gj~,-ar" wi4t "Si;;n~nrr~r rf hrin-'i; .,' Frt_~dive Qrr_•~,- of /+r.,lh~~-iz,t,~
<br />f'gznt, ""TelaFh mz NurnF,:r,"and "G.rta" at bottom of form.
<br />13. Pail signed Report to Office(s) by date(s) specified .n perntit. Retain copy for your records.
<br />]4. Utore detailed instn!etions for use of this CLs_harg~ ,'Vionirori+re R.7:;,t (C?.fR) form may be obtained fivm C`[icc(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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