|
~a~erwor~~ ~~ :~:~~~on Act Notice
<br />:ing burden for this collection of information is estimated to vary from a range of 10 ho;;rs as an
<br />r response for some minor facilities, to 110 hours as an average per response for some major
<br />~wtih a weighted average for major and minor facilities of 18 hours per response: including time for
<br />hg instrtctions, seazching existing data sources, gathering and maintaining the data needed, and
<br />teticg and reviewing tha collection of information, including suggestion for reducing this burden, to
<br />;Information Policy Branch, PM-223, U.S. Environtnental Protection Agency, 401 M Street, S.W.
<br />ingtou, DC 20460; and to the Office of Information and Regulatory Affairs, Off ce of Management and
<br />et, Washington, DC 20503.
<br />~t'~";~:y;"21 ~~l~~iructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />Preprinted.
<br />Z. Enter "Pernritlez Nan, e/;vlailing A~.lrzss (anti facility nave'location, if different)," "Permit Nuntf ter," and "Discharge
<br />Nunr[,:r" where indicated. (A sepazate form is required for each discharge.)
<br />3. Enter dates beginning and editing 'SYfcniroring Peri1;3"covered by farm where indicated.
<br />4. Enter each "Parm;lster" as specified in monitoring requirements of permit.
<br />5. I'.nir "S.l,n~/' Ms.lsu,zmznt"data for each parameter under "~iuanri^'" and `7ri rn,,^;u specified in pcmlit. ',h _•;'.T~ ~" is
<br />-~-'~;~'ly mithmetir.: verag:, (gcomenic a\ cragc ror bacterial pcrancta") of zll sain!l;r mcasurcmerts fur each para~netcr
<br />0!a: d1C(1 Benno "r, :,]%lO: I/l~ f~11"; ~n; rrl f_LT %aiibr." anC %:11:II1..'l,i;" S ani)"^111}, G;afGnlL' hlg., a)d ]O\ti mCa$Lri.mC:liL
<br />nbta iRCO d Vlzng ",..:nr1 iYll:b^ ; ~_'17 i !". (~~ aa: lv mL'„~C1~a15 1Y1'~ lAOn ilry li'GamCTi rZ e. "CTCCt; I_n(dr 3(`i-Ca)' 8\ C"'2~C
<br />Oi'-Cn1p1C In Cutiure iTCn CS LL.-i('.Cr "f~"l,'~~, •~ :^d C!tfi T7Z::,min,". ~-GPy aVL',8(;L' Oi~S:,"T' l'~ inC"SllRrIC~LS UtJla ina~' ~!n~l~
<br />mc•n Loring period under "idarinu,m.")
<br />c. :i:) .: "/' •, rd1.R •.~ci,'~„rsat" fcr each parameter m)dcr "~u.rlliilp°. .: "r, a1ir;.' as slrci icd ail pe,-r:~'.
<br />7. Jrdcr " , .." tti .r numbu of aar~'c nuasummcnt dorin~ err i;oing j1 'ad f"a' c.~c_. r::a:i Hain ,cndior Inini:~;urt
<br />_s 7-dc} a~.r, : _. c;,proms;ialc) pcn.ii r:q'.`.rtmdnt for caCil p:~amcter. '.; ennc, enter "0"
<br />!;_ "i) ~°r: fAn.rlrar."Seth a~ "O •;qdr ;r(r~•. n.:;h,:"(. true' fre.::c •'s~rnn'inr,• : rd rtnri psis csed d~ iin~
<br />-^eni,arnl; p~l`.ud) and .s ", _. ~.~if I1~';ni,'~;: s," specified ~n rcirri'. (c.g. `:nt_~ ~~'a.T! " r:r coaC ouous iraniic-ir ''!/7„
<br />ror one day per ,.,..::;, "I/30" for one crap _ .r inanth, "l~'9II"for on'a day per guar,,,, ew.) V
<br />~'. .: "Slur, !'T;; _ boGl as "S_>r,r, r.: ,1,'.r_,~r, '„~_,,."(r.craal stmp!c ;},,r u,~d ,fu,in3 :novi;c:ing reriol) and os " _, ,,: f!
<br />P~yrrlr~ul~n,," (c.;; ?ntcr "Drat" fur ;ndi•.iuuzl sempl:; "2•;r'.. fcr 3M1-i10.'S comllnsi[c. ".):%i" far continuou
<br />manitonng, eic.)
<br />IC. );'.icrc r;rletions c`perrrit ree;utre~.)o)t, aro re;.~ ;Ld, attach a b~ic~ c; p!cnu;;on to describe ce:.uc end corroctivc action"
<br />to be G.l:co, ;,nd reference each violation by date.
<br />I ?. If "no discharge" occurs during monite: in, pcr.'n3 ertcr "No Discharge' acres:, fo-r in p'. ee of data cntr} .
<br />12. °lter "Ar~,nJ; iN• cj FrinaP _l F':':1+rfi:• ':(f_ lr'' aith "Si;.nahn•~ rf r~-i,,:[i. a' .Sceaui:•~ Oj'i,:e; lif rurho;-izzt
<br />rodent, ""Telzpl:nr.: Nvmhe,•,"and "L'_lr,:"af bottom cf farm.
<br />13. P:fail signed Report to OfFec{s) by date(s) specified n permit. Retain copy far your *eco:ds.
<br />IR. \4ore detailed instructions for use of this Gis.ley~,;e 1"f-~nir~, ind Itapcr-! (L':'~fAJ for,n may be o'.)tained fmm OfFce(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.P.R. 125.27). Failure to report or failure to report truthfully can insult in
<br />civil penalties not ro exceed $10,000 per day of violation; of in criminal penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320.1 (Rev. 03!99)
<br />
|