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Y~ L ~,~r~~rlc Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vay from a range of 10 hours as an
<br />average per response for some minor facilities, to ] 10 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, including lime for
<br />reviewing instructions, searching existing data sources, gathetirtg and maintaining the data needed, and
<br />completing and reviewing the collection of infor-utation, uncluding suggestion for reducing This burden, tc
<br />Chief, Information Policy 3ranch, PM-223, U.S. Environmental Protection Agency, 401 N Street, S.W.
<br />Washington, DC 20460; and to the Cffice of In.°ormation and Regulatory Affairs, Cffice of Ufanagement and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregazd instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Fzrnrittee Mane/Mailing Address (and facility name/location, if different);' "Permit Number," and "Discharge
<br />Nunrhtr" where indicated. (A separate form is required for each discharge)
<br />3. Enter dates beginning and editing "Msn%ta-ing Perio.i"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. F,ntcr '(S_nnfh ,bl ~asru-~mzn!" data for each parameter under "~u~ntinr"and ihealilp" as specified in permit. "Avtraga"is
<br />ormrlly a irl.tmctic average (geotncuic avcrzge fur bacterial pafamete*s) of zll sample measuremen's for each parameter
<br />obtained during "a1.uP.ring f~~r%;_t"; "ril_~rir;renu" mtd nlini,ruun" arc ^o~mally esr,me high and low maasu:~~cns
<br />obtainer dwi tg '?•~~,u;i;,~i,r8 1'eri•, i". (Vote to inuair.pals n~i0r secondary treatment requireme tt: Ln+cr 30-day average
<br />O~SC?~~rC ,n^_a~L'"CmCr iS UnrCf °!.°1l'.e~_ "~ d Cater atUCImLLR 7-da; aYCCagC G~Sani plc mC3Sl TCm JRiS ObtalnC.1 Cl'rl^.(;
<br />mcnitoring period under ,vlaximunv.")
<br />G. °n~"r "F,•.;ni12./r~i.~_m~d!"rorcach parameter und~_~ "~r~,rr'h'"~"'~ ";,Jrra:itp"as specified intermit.
<br />7, ~;,u,.~. "i'~ F:" e~ais cumber of sat-nrl~ ncc.ureme~~: ~ur~~,~ n.o~:'io inq ~~~,.rn;; •r' .. ~~. reed ma~ino.m {and/or min~rt'urn
<br />or S ''y a~~crtge as atpro~ri,le) p:nnil rc~u~rcment fur each pz!~me'er. if non c, entr ".J".
<br />S. .:r,ter "Fr -1 ,,,, T ,,f r',r Alps'`"br,th as "Su,r~!• ...~.r,~,,~_„r'..f" (acbitt frc;h:c,,.C„ ~ ~ ~.•r airg ant ana ysis usca dar.ng
<br />~nun~iorrg p~:r;o:) and as "r_n,rir Rd~rrir_ar_rd"spceiLrd in prrrrt (r..b, t:c!cr' .,,ii,"fcr contin'~O~.i° n:onitu~-ing, "+/7"
<br />fcr o tr ri:,y per t: cc:', "1/30" for nne day rCr m:mth, "tl90" fur one day ~cr nuartc~, c4.)
<br />'~. nu "S_,,,, +• Tj, s"boGt rs "S,u,all. ;„r.-c,;~~,,;err; •• (trturl s._rplr [y;.~ a~_d du+i,~ mon,to~n~ nericu) r• .' as " -.,ur
<br />(i~~r"~,azel " (e g. Enter "Cr.~l " for fndividua! ra-.plc, '24/! ; ~'ci 2~: So.!r composite, "~\%L" fur cat. uoi:,
<br />monitoring, etc.)
<br />1C. '.:n•.re `;iola5i-ns ofpennit rcyuifemcnts arc reported, atiaca a brief cc~lane~ion [o dcacibc csu5c and crrxclive ac.ioas
<br />io be ta:cen, and reference each violation by dale.
<br />1 t. :""nc discherg." occurs de-inl; monitoring p_tin'?, entry "T!o Dis~hnrge":.case form i~t plcee ofdarr ent~;.
<br />12. L'nter "i:'.~;a~/Tilt- .J rrin_ipa! Fs~.-irtir, Gfj''~_, 'with "Sib`r-utnr, of Fri~~ ;,-,.r 1'a._~rriv_ Gyl_e, of l~nb5.,.-iz_`J
<br />Agent, ""T~ l~ p!, .n ~ Aruml zr ; "and "Cats " at bottom of form.
<br />13. ir`: it signed 'tepcrt to Cf(ice(s) by dab(s) specified in permit Retain copy for your records.
<br />lv. A-ion detailed instructions far use of this Gis.aurge .Llo;rito,-iug hsf :. t (I',tDi) fin,n may be obtained from O:Ticc(s)
<br />specified in permit
<br />Legal Notice
<br />This report is reyuircd 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 oo[ 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 Forty 3320-1 (Rev. 03/99)
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