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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, seazching existing data sources, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of information, including suggestion for reducntg this burden, 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 Instructioas
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permrttee Name/Mailing Address (and facility name/locatioa, if different)," " Psrnri! N7emFzr," and "Discharge
<br />Numisr' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Mo77itcrirrg Period" covered by form where indicated.
<br />4. Enter each "Para ,peter" as specified i^ monitoring requirements of permit.
<br />5. Enter "S nnplz hfururznenP' data for each parameecr under "L ra77riry"and Quali,}'"as specified in permit 'dvzragz" is
<br />normally arithmetic average (geometric average fuc ba~xrial parameters) of all scrrtple n,casuremenls for etch pa,arncicr
<br />cbiamed during '7Y,onito.-ing I'er-i:d'; "d; _cAna,;7" and hfi,:6n;un" arc normally extreme high and logy meastuer.cnf;
<br />obta~nel during "i ;G,ri1~rL•7g PzriGJ". (Alote to municip~~s ~+i di secondary se:a.~c.l, r: ;ciroment: ntzr 3Gday ave~c~~
<br />of sample measurements under "Arz--lb_,"and cY.er n~zimom 7-day average of sa:nltlc meassrmen', oi:mined d.r' L'
<br />monitoring period order "i/.sximum.")
<br />G. Gn7_-':°„,;: i!2•far•',ez;7/rr roe cts't parameter node: "~I, '/711 h'"rnri "l,]/J/1(}'"1S SrIf C1t~C( i`r: T: 7..
<br />7. llr,t:er "Nv F_- number n"se ^; le mcsurcm.; - d... Ong n~eniicrn~ = ud !'tat c: a:c~ ,..:im .m (: rl c.r I~,i^' _,.
<br />or 7-day &v:.rege as c,,,trcpriste; pewit rcc;air._rnc; !far each par;nctcr.Vlf none, c.t[e~ "^".
<br />i,. ,pier "h', ,.i.:ur,y cfl..r_'lysc"both as "S_ „I; '_ ...' .7s°'s„I~e~" ;a~b_al fra~ucncy of se .tpii tg n~ an ~'ysis I sec c: ;,.~
<br />mu tito-ing p~; ioi) ~r 1 as "I'bi,~li tid fi!V2:,r_,, •'' $h2.:il:d in pcmli:. (C.,^~. ''iL:i n",.,d, ° ~Lr COn1n7Cn~c mJ^ILUi;':~, °f/7"
<br />for one 1,~y per t•; ~~ °';, "1/?0" ; o~~e dr t;rr mon!h, '7; 9D"for one day per quaver, etc.)
<br />9."'.irter'$1:rFlz T~E "bul~._ "i_•I:~!a . .^sm't..a!" (rc.t~al sr.mflc ly; ~ ~~sc:l Gur n~ rr.nnita.'n~ _~: ~ m: ~, _ , 7'
<br />. ,:
<br />/Zyuire,ue„1," (=.,; En;:,: "~;,1'~" for ..~divic'.u_I &'tmnlc, "1~;,'I"' for 2~-Fc:!~ ro .pcsitr,, :''/A" fo n. :e,a
<br />monitoring, etc.)
<br />10. \',^tera violatiurs u'; cnnit -eye' _~oru, ai., r,:poi' .d, rtttch a h: ie~ e::p:un:rt .n to ~ :, c•i;te reuse ' i . _~ T.:c''•
<br />to be taL-cn, and refcrnce each violation by date.
<br />I I. if "no rrise:targc" ucco ., duli:,~ -o~;t~ inf per.'r.d, en'c^ ";:o C'se?le*~e" a;.;oss fc -m in pr.° : u°da•. a `,
<br />12. Sn!er '7Vl7ae/Tf!!r GJ ~,~i,r;y.~/ I'': ~_:7i1•z GJJ'- li'ih "Sib,; .,,c'. of !'rra_%~_ ' .. _, -;.~. ',,~'' ,' . '
<br />Age77r, ""TzTeD'7Gi73 NuL7hzr•,"end "Galt" at bottom of form.
<br />13. Viail sip ed Re;,c t to Cf"°es) cy ~'-t(s') speciGcd in p"miL Rel.=in copy furyoe :e~o~~'s-
<br />1~. ~~0'C LetallCd InSli JCt'OnJ fOr ~1SC Ci Y-.IS /-i.P:/L~e ~1 f'41",%i7~ fllf'.,'i Tc~i~ rC -..1 ir_; i "' .~ _ ~,
<br />specified in permii.
<br />~- . ra
<br />~w~c`._il ~~~'~il~~
<br />This report is required by law (33 U.S.C. 131 C; 40 C.F.R. 125.27). Failure to report or failure to report trothfclly cr:~ c , '.
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of vie.:>'`.:.~ ,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-2 (lieu. 03/99)
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