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~a,~~e~°~v~rk ~e~luction Act Notice
<br />Public reporting burden :or this collection of information is estimated to vary from a rangy of 10 hours as zn
<br />average per response for some minor facilities, to 110 hours as an average per response fog some major
<br />facilities, with a weighted average for major and minor facilities of 18 hours per response, including time for
<br />reviewing instrttctions, searching existing data sottrces, gathering and maintaining the data needed, and
<br />completing and reviewing tiie collection of information, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. );nvironmental Protection Agency, 401 M Street, S.\V.
<br />Washington, DC 20460; and to the Office of Ini°otztlation and Regulatory Affairs, Office o£Management and ~I
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of tbaY information already
<br />preprinted.
<br />2. Enter "Pe;mittee eYame/rLiailing,4~Jiess (and facility name location, if different)," " P~nnit Numh=r," and "17ie,;F~r~~
<br />T.rumher" where indicated. (A separate form is requucd for each discharge.)
<br />3. Enter dates beginning and editing "ivicnitorir,g Prris~"covered by form where indicated.
<br />~. Enter each "Farametsr" as specified in monitoring requirements of permit.
<br />5. Enter "S~~mFi.; iv;_~sr; ~,nsnl" d:s for each par ~c:er under "' u~r,tiry~" crd ~-u~liq'' as spcci ~~r, in pennii- "Al:-ws_"is
<br />ncr:,lzlly arithmetic average (,c^_-.c!:ic nvcrag, f,r Uac~.crial pxiaa~eters; of all sampl: measurcmc;as for each par~mr.~ r
<br />obtainer during "i~,:.,•ir.r.`,,,; .`:;i.l"; ':1L.ric:•nn" and ,."Ji::D:vrm" 2r. no,mal!y ~.~!rcrnc hill and iow measuremecl,
<br />ohiained durirg ".. •„nh,rin;; fir, .l". (N,nc to n~:micip:l.; ~.+i:h Ica+nd,ly treshn.~ ~ icq.r ..,rent '=rtLi 30-d.~y rvrrng~
<br />of sample meant: encn,. ^n6_- "drt,,,{ ~,":~rd enter ^~:uiw•„ 7-day a~~c,::ga c(sanlple m~a uic ,,cn ~, obtained c;uru'g
<br />maritorirlg period under '7~i~xi,nu:n.")
<br />6. Eos_r "Pur,n:' T4•:Ir'i,-s,r~_c!" for r: c'. parm ier under "zit' ~.,~in~" anc: "~'!li?~~" ~. ,;,rcific i in ycTi:.
<br />7. lindcr "i~'--> E•." cnL^- number o :amp!c ~nccsurenci d~rilg mcnitu imp _~~cd i~r t ~ .cced nay mum t~ r. ~%ur ni ~ 'lure
<br />or 7-dcy a.v;.rege asq:prop,ia~.j pcn'~,~: ,rqui~ emcnt ict r2ch parametc-. ti none, enter ".; ".
<br />R. :c. _r "F',e;'tvtt.~, .1' • u!~•sa" ~,cC~J cs "3~.a, 1~ .',.: -er t,o •.'" ;.rlu~lr.: _ ~cr ,f s~~ar~in~ s i.l anc.l,,°s rsod du;~ 's
<br />fT7 On'.:OI'17f~ pi CipU) a~lj 2 ~ "t'-',a:' 1`' ~:V •7U: =11~ •'sp,.C~IICd ill (,C 7WL. (c. °,. ~:P!C' .- " 1C" Cnn "JO.S R'UP!lUl']n,c, "I/~"
<br />Cot ooc day p.:~ rvee:c, "Ir30" fu: ouc aay p~. u:uuth, "IisnO"Cot ouc day per quote.-,etc.)
<br />S. ~nLr "5~-„t'a T,~Tr" uoth as "° n,.Cl.• i :'_~s.,.~~,,i_•,,."(actusl scmnlt l}'Pz,~cd during,^ur.itorio~ pe cd; an_ s "I':~,,,,i~'
<br />IL•/.d,-s:,r ;d," (c o. Enl_r "G,•~; " for iadi~ ic~oal s•unplc, "?~11! ~" `a~ 24-%~c ~~ c~:~upositq 'SViri " Ccr conttr~uu:;
<br />monitoring, c*c.)
<br />10. ?',there viold%orts uC,~ermi[ regei-ements a,c reponcu, : i'ach e brcCc::planatien to _nrribe arse and eorrxtive a_'ions
<br />to L•e taken, and reference each violation by date.
<br />]'.. 1. "nn disch.•t.gc" occurs d_-ing mnnitor;no period, entu: "i~lo );ischarge" scress Corer. i^ place oCdn;n cn.ry.
<br />l2. En'e. "i•r~tatlTir!. ct Frin,;iCt,rt E.~ ~7rliv~ G~:.•_•," with "Sitina,t-r_ oj` Frb:_iE.~( F.ie_-trtibr t7~__•r rf Fudr~..dzs-.l
<br />iil,•znt, ""Tz1~F:rc.7z NurrrN„r, "and "CJtz" at bottom of form.
<br />13. Nsil signed Rc~ort to Office(s) by date(s) specified in permit. Rctaur copy fur your rwor45.
<br />14. ivlore detailed instructions for use of this Cis_h~tbz 7vtsniroriug R~TsrI (lJ.h,77J form may be obtained Gam OtTicc(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can result in
<br />civil penalties not to exceed $10,000 per day of violation; or incr~al 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)
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