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I'a~erwork Reduction Act Notice <br />Public reporting bwden for this collection of information is estimated to vary from a range of 10 boats as an <br />average per response for some minor facilities, to 110 bows 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 sowces, gathering and maintaining the data needed, and <br />completing and reviewing the collection of infonmation, including suggestion for reducing this bwden, to <br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, 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. 1f form has been partially completed by preprinting, disregazd instruction directed at entry of that information already <br />preprinted. <br />2. Enter "Permittee Name/Mailing Rddrzss (and facility name location, if different)," " Pzrntir A'umber," and "Discharge <br />Numbzr" where indicated. (A separate form is required for each discharge.) <br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated. <br />4. Enter each "Pararne[er" as specified in monitoring requirements of permit. <br />5. Enter "Ssmple Mzasurzment"data for each parameter under "~JUantiry" and Qualiry" as specified in permit. "Avzragz" is <br />~ normally arithmetic average (geometric zverage for bactzria] parameters) of all sample measurmcnts for each parameter <br />obtained during "Matitoriug Pariod'; ".t'lzxinnrr.t" and ,bIIav»um" are normally estcme high tied low measurexerts <br />obtained during ".!•:onitrrirtg P~rird". (ATOtc to municipals with secondary trcntment acquirement: ester 30-day avrra~c <br />of sample mcasTUements under ':".vzrses,"and enter ma;:imu-n 7-&:y average of ssmnle meas•.uenents obtaircd :: Ong <br />monitoring period under '~r/axirtam.") <br />6. Enter "Penri.~ Rzqui, zrrrnt"for each parameter ends "tuanliry" sd "'~7ualiry" as specifieG it permit. <br />7. Uncer "A'. L•~" ente* number of sample mecsuremen' during mcnitor'r.g i,en.ad that r~cecd rna:cm. -n (:.nc';or mini r. m <br />or 7-day r.vcrage s appropriztc) permit requirement far each parateter. if none, enter "0". <br />B. :'nter "Frzquar:=y ofAu~lysis"both ~s ""na}-L S"'zc~az,n.-""' (actual Ra_iu:ncy of sa-np(ing and am~'ysis used d~ r.r,~ <br />monitoring period) ar,d as "Pe:~tit 2;rrb•a+;u: !"spec'`ed in nc.rtit. (c~'. ~ntcr ";'~;rr,"for continuous monitoring, "r/7" <br />fo- one day pet wee::, "1/30" for one day per month, "1!70" fee one day per quarter, c'c.) <br />S. Enter "Sa:nF(a TyFe"both ss "S1,nriz l.','~surra_r.1" (xtual ."ample type t_4cJ durirg mnrtiU~;ng period) and as "''_~;:ri; <br />R~3uirzment," (e.g. Enter "vrsh" for individu-.1 rample, '7R;1:;" fi;r 24=u:or composite, '7J/A" for continuous <br />monitoring, etc.) <br />10. Plherc violations of permit reeui ~-moots zee *zrotcd, z[SCCI~ a b~~cf explaa:.ttinn to descrbe cause a_nd corrccSvc action< <br />to be taken, and reference each violation by date. <br />11. if "no discharge" occu-s during manila; i;~.g period, en'cr "i~'o Cischarge" across form in n~ncc of da*:. c'try. <br />T2. Enter "Na:ne%1'itle rf Princi~~l F.~ ~cafiu G~_-z:" nab ':Sib,T~!tu'e rf ..^rt.T. i; :l rzcrli>> G,T=' '1 rivlbo,iztl` <br />Agent, ""Telephone Nm»bzr, "and "Dat_ " at bottom of form. <br />3. Mail signed Raport to Office(s) by date(s) specified in permit. Retain copy for yoar records. <br />14. More detailed insL-actions far use of this Cisahar-a d:,nitsri,g R~r;,7 (On.'I~ fora nrry b~ c;b~i-~„c. f om !"`~ (~; <br />specified in permit. V <br />7` \f7 <br />Y`J <br />This report is required by law (33 U.S.C. 1315; 40 C.F.R. 125.27). Failure to report or failure to report Wthfully 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) <br />