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~=~^ ~~~ =~~~~ork ~.~,~uction Act l~Tot~c;~
<br />- ~ .t. ,:s
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<br />Public reporting burden For this collection of information is estimated to vary from a range of 10 hours zs an
<br />I average per response for sore minor facilities, to 110 hours as an average per response for some major
<br />I facilities, with a weighted average for major and minor facilities of 18 hours per response: inclc.cling 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 reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, BC 20460; and to the Office of Information and Reguiatonr Affait~, Office of Management and I
<br />Budget, Washington, DC 20503.
<br />~cneral Instructions
<br />1. If form has been partially completed by preprinting, disregard instnrction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pzrmittee NJmz/Moiling kddrzss (and facility name location, if different)," "Permit NumFer;' and "Dischmge
<br />NumF~r" where indicated. (A separate form is required for each dischazge.)
<br />3. inter dates beginning and editing "lvionitorirg Feric:!" covered by form where indicated.
<br />4. Enter each "F~r~mete~"ns specifed in monitoring requirements of permit.
<br />5. Fnter';S~nrt:':'i;_.csr«-era_n/"dat<foreachparme:erundo"~'v.^+nit;"a.;d~r~l%h,•"ase.pxiFedin permit. Avaradz"is
<br />,~ormrily s~rithmeGc .a erage (geometric avtr.;;e for 1'ac+crr,l paramctc~s) of all sarr~plc measuremr_nls for each nrmmct~r
<br />obtained dLnng ":1 i', U!'SI'illo F2i1. ~"; ",.i~rlhrrUn" and /.lriln Vl01° arC ROTn~lly °':i "zme hlg)t and tnW TIeaSUrC ~CntS
<br />ob2ince :]u~ i,g "!„ o ::, iub F~;i•!". (T~'ote to a._r!c oats c:i", sccoRdan,- Lreuimcnl rene-emu,i: Enter 3G-day avn:fie
<br />of SL'1n1C IrCCSL1"C^-:: -, Unc C! "fi'.r_'+-.lo.'. E?~ Cn:Ci I'~tYainnra r-G9)r aVL'r'a~C Ci s_n,pl,; mC85I1rCm:niti ObtaiRCd ("L7^g
<br />mananring period unccr ":v; xirnem.")
<br />E. 'into*'~°.~,,,,;rR:., .,.,,+_. r,, :c. ~echpsr.,•,ck: ord_, ` _,. '(I "u~•_ "L~u ,'i;,"assn:cifirdin emit.
<br />7. U^det `!.'~, Er" ea!.• •u~aSc~ o`,a~r;le m•.~.auremrn+ ?~.-in;; n.r;.- '~t i~~l r =~o! :- ,.,teed mar.it-.,mn (•:~['do~ mir~~-um
<br />u 7-dry a: cc~ as eppro~rat•_) ..emtit rca,~_ z-!~ nt ~c: cac', paiamc'c. If n^ne, c re "J"
<br />ti. hire- "1•'r_ , ::rr,~ ~` .ulpsis" i:ct~, ss ' • ' • :L::. t,a :.. ,c" (::rtu:.i freriucr _•• r" -: T l ini arr3 an.d_rsi, i seu rluri.+g
<br />r~'on::ar.~g;:etiod)!.n:<<.~"f:r,.drR;.u•ir~.,.,~_,:r":. ,c~_iF-~, in ;,~,•~~: 'c.~. L:~.tr; ..•.r;,'frrconi: tuocv monirorr~. '~//7"
<br />fr,' one d.~y +,:.r sti _..':, "!/,;'p" in, o,,e ray per mun~n, ' .,'40" inn o:~a d^y per qur.>'r~, e~_.)
<br />~. '=nl; r ".5,,,;~ !~ •,.,: ," bol t c5 "S-,.r~ is ,~ ,.., r" (,:.Cal s. 0;~,1~: ty,ic o.cd c'on: ;; m ~.~l~or'ug :~cr.cu) a-d as "~, ,.r~
<br />;~ rir,,,,~,rr,' ~tcr "vr.,i" for .u~i,idici ."~ "Z4N:" fc: %4- corrno ' f c ~ti c
<br />•~ (r,.C. p'~~, ''c_ site. ".1/d" or o. ^ c^s
<br />monitoring, etc.)
<br />1C '"':°re vic!.aionl, , r~_rr,it reruiromcnis ,, r; c, irn'n', a'?.:!- a `r,ef e><p'rr,tinn ; : d:screbe es~se anj enrcefive a_'~ is
<br />to b° taken. and reference each viclatioR by r.:tc.
<br />t. i"'ne d~sc~rcr~e" occurs de•in;; r,nirorin~psr.o:'; er,i: ""a Qi~nc~rgc" acrecs fum in phceofdata ~nsy.
<br />1%, lamer 'SV~,-,tz/Ti!/a r.(i ii:1Ci}~~r F. _•,.rrli•.~ ;~jr _, •,,ith "S;en~nr-'z cf Fr+.. ~j ~' l:.r.r_r,rist rfJi~ei rf fr.!;r,r%:c1
<br />/.b sot, "'TeltpGon_~ .`h rni _ "and 'T~r."at bottom of form.
<br />;3. ?/,'ai] signed 2epc~i iC Ouicc(s) by ciuW(s) specified ~n pemit. Retain copy foryo~~rrccords.
<br />l4, Moir. detailed instructions fe,- use of di s• Cisauro_ Iv;oni!^,iub F_r„r ([`;'•tP) fe~m may uc obta~ned from O(~ice(s;
<br />specified in permit.
<br />I.,egal Notice
<br />This report is reyuired by law (33 U.S.C. 1318; 40 C.T.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 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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