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~~.:1)~~,A~~~1~ ~~~~~~:~.~~ .Act I~Toticti
<br />Public reporting burden for this collection of inforznation is estimated to vary from a range of ] 0 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 hour.; per response, ixluding time for
<br />reviewing instructions, seazching existing data sources, gathering and main'.aining the bats. needed, and
<br />completing and reviewing the collection of information, including suggestion for reducing this burden, to
<br />Chief, Information Policy 3rartch, PM-223, U.S. Environmental Protection Agency, 40] M Street, S.W.
<br />Washington, DC 20460; and to the Cffice of Information and Regulatoq~ Affahs, Cffice of Management 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 ttat information already
<br />preprinted.
<br />2. Enter "Permittee Name/idoiling ~fddress (and facility name location, if different)," " Farmit Numbar," and "Discharge
<br />Numter" where indicated. (A separate forth is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "PRY,/In~leY" as specified in monitoring requirements of permit.
<br />5. Enter "SanrFk rV,_ lsru-an+ent" data For each parameter under "~euntir,: "and Qu ~liq•" as specified in permit. 'Av~ras r" is
<br />normally arithmetic average (geometric average fi7r Bacterial parameters) of all sa;nple measuremenL~ for each narn~~neter
<br />ohia;ned durng ".Llze!r;ring Parisd'° "d4.axiunuu" and ivlinimrun" a,c normally .:.a~,cme high and low mcasure~xn±s
<br />obla~neu dwing "d t, ~i;;,inb Fari~d". (Tdote to n-:w icinals v:i.h srcondar;~ tcztmcnt rul~~retnen.: Etter 37-day zvc.agc
<br />o(sam,4; m~n;wcrnen5 un&r ".4r~_raoe,"and enter mrximur.; 7-day average u,".+sr-nle measuremcns obtained darirb
<br />moniuring period under "lvLiximwn.")
<br />6. Gnl•:r "F~~;,nirRyui:arr_•a?" "or cacti parzmeter unc,-* "i.u,~~irr," ana "ua!iry" as specified in pcrm~:.
<br />7. Und:r "iJ~, Er" ent. r numBc.- ni sample m:aarrc:hen, uurng o-~~~ ~ ink: ~,:rio~, ,`. t ~3e~c.i m:>,imurr. (and/or min;•rrun
<br />or 7-d+y avenge. as eppronriz(e) ;:c~ ~ni( rcq:.i~timeM for each pararncccr !f aen_, e ~wr "0".
<br />II. °u:ems "Fi an_7~ •f.;,u7~•sis" fcf, as "S_,.y r• 1,;1~ ..,, ~,r," (a~t.zl Crccucrcy r.f s: •r,l;;ir,~. r.-~ aralysL; :•se:; d.:ring
<br />mon;wr ~;,• per ioG) a ~.:~ as "P~r;.r'i 2,iui;~°r,:_,"~^ sprcifc5 in j,e; i"i'. (c.g .c?~: _ ,. v," frn~ continuous roni,uring, '7 /;'
<br />r. me clay Per wee}:, „//30" for one clay per montfi, "!/90" for one day per qua: ~,.r, c.c.)
<br />S. iinta ".S, ;.fr_ ;y,- _ 'both as "S.,,q , • n<': ~s, _;,~ ~ :, ., (~_r e1 ~,:r-.F', tyfe ..,ed dur~rg m.oni(orin~ pr- oci` an.. zs "r ~:,,:p
<br />ji~.l r,i,-'ml,~., (e.g. ?nlcr °Cii'.I!-'• i0i 1,1L:\9411.1 S:'il~._, °_'~'li .' i::i 2~:-~'... lnnl?OS1 iC, ':~.//. •' rUr COnr'~L~Gt~S
<br />monitoring, etc.)
<br />12. C:': ere viols bons nrpem,it requirements z:,: cpo: c:,~, attach a Ir ref eaplanutin : tee dc;crihe caase ana ccrrective.!.:iu,r.
<br />to'm taken, and rcfcreecc each violation by sate.
<br />1 t. If "nc discharge" occurs during monitoring pcrio!, cntar "A'o lirdrargc" across form in p'occ n`data entry.
<br />]2. F.mcr "R'~,nc~/Titfe ~f PrinciF~l F.a~_~e(i~ e Gjj? _, ' wirii ':~i~rulr^~e cj Fri.r_i! ,! Ex..r1,'v_ Q~Jixr ,,f lerlr,ri_t,1
<br />A~ znr, ""Tzlzpkor. e : krnrL a. ; "and "Cate" al bottom of Corm.
<br />l3. Mail signed Repocl to Of;ice(s) by date(s) spcci Ged ~n permit. Retain copy for your records.
<br />14. lfom detailed instructions for use of this I~is.lrarye rL;•ariroring R_j•.rr (GI~I)~ form may be obtained from Ofricu(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.2'7). Failure to report or failwe to report tnrthfully 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)
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