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Paperwork Reduction 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, 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 reducutg this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Sheet, 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 />General Instructions
<br />1. IF form has been partially completed by preprinting, disregard instruction drrected at entry of [hat information already
<br />preprinted.
<br />2. Enter "Permittee Name/Mailing Address (and facility name location, if different)," "Permit Number," and "Discharge
<br />Number" where indicated. (A separate form is required for each dschazge.)
<br />3. Enter dates beginning and editing 'SY7oniloring Period" covered by form where indicated.
<br />4. Enter each "Poromeler" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Mtastzrsne,rt"data for each parameter under "Quarrrity" and [hrality" es specified in permit. "Average" is
<br />nornraL'y arithmetic avenge (geometric average for haetzrial parmeters) of all sam ~Ic measure mCnts fcr each pmantcter
<br />obiained during "Pv/onit~,rins Peri;.l", ";tllxin+~rv" and Ninh,rsm" are normally el~rmc high a~td law measwumcnu
<br />oS'.aine3 during ":::~rriLriod F_ri•.l". ;Rate to mnaicipcls tuith secondary trcc,ment r. ^cirmrilt: rolcr 30-day arctagc
<br />of scmplc rocasurcm,nts under ' v~ragr,"acrd enter mc~imu-n 7-day average o`s: , ;.:z mcas~ra-rcntr, obtains? d_:~:rg
<br />monitoring period under '7oi aximum. ")
<br />6. E-'^~"?~n.;~rRe;r~ir~rn,r;tt"forerchparamc:crund_r"~r~a;,lir,,"rend"Qi~~a/ity"as e,~eci~icc,'tr:*-~i'.
<br />7. Ur~Gt ",v, C.:" e~ Lr number of sam ;lc mr ~ cr- , t' daring mon'tnr ~~ _r C '. : r r- 'e:°' -n-S..~ .t (mr_'or mini, '_..u.
<br />or 7-ray rvz'~ge as anprop~at_) p:nnit renuir~rnc~;t fc,r zacb par.,mctcr. Ifnore, c~tr "0".
<br />0. .Inter "F.,?acn~;~ c~`fina/y.-R' L•ath es '.i qr L ,:9 .rs~~. a;r ~!" (rctuct f~ r.u.nc; C'sL .ll:i nu , n:',:.is used d, rirg
<br />nanito ing period) m!-~d as "F.,.:.i! Ra~:c. _n -,~'"slxc;ficd in permit. (c;,•. 'inter ' , .. "'or co^' uc.ws mcniion tg, "!/7"
<br />:o; m: dry per wee';, "Li30" .or one day her monG~, "//?0"fcr one day pc; quar'icr, ci.:.)
<br />9. ?arc: "S_•.r le T" . "botL as "" n; 4 : c"w ~u;.•, i"'ac:ual sam tc o oscd dv;'r~. -:nitr 't t::.;` .; d as ", _,;ai!
<br />T~-/.~i. ~;u~el," (e.o En...- "~;~>•" fnr individu^1 sair~lc, "1<J/1~ fo: 2~'--'"~~ r.., -;;as`fa, "?'/ri" for con'`ncous
<br />monitoring, etc.)
<br />10. \Ttere rol~tions ofpe:mil ~;~' ement u c r_po-[ed, alirdt a brlafe:;nlaaat'~~. to [cc^i~e •.c,e~ :.d co ~sticc ~_tions
<br />to be ta.''ea, and reference cacti violation by date.
<br />ll, rf°11UC.tiC1a'(',°"RCC.:idli.'i7gi?QRliy"ll'~penod,cricr'^`o C' ...=rt;r. ._:c... T, _-: c".. _ ,
<br />12. inter "A'~,rer.Ti6S .-•f I'ri;r,iFul Er~t<<tive :/jeer" ardt "Sr;;ns'-., .. ~.f !', ..-. _ '-„ -. ,'.;r~..,,%:eJ
<br />Agant, ""TmIzTSoae Nmnha;"and "Cate" at bottom of forth.
<br />13. tiiai; sig,ed Reno, i to :,mce(s) by date(s) specifia~ in ponnit. Rctaio capy fur, eu ..n i:.
<br />l4, i•.'ore detailed ;nstructions for nse of rigs Lisc/r,r ~ ;.r~~ai!;.:a<; R;~~i! (D.~.;,1 'n• n - , c' '. -d Ga,... ~s`
<br />speci$ed in permit, rr
<br />~~~~~ ~~~~{~LL~i~
<br />This report is required by law (33 U.S.C. 131II; 40 C.r.R. 125.27). Failure to report or failure to report truthfully eau r:v..4 i
<br />civil penalties no[ to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of viol~.ir.,
<br />or by imprisonment for oot moce than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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