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~'~~P~-work Deduction 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 pcr response for some minor facilities, to 11.0 hours as an average per response for some major
<br />facilities, with a t~~eighted average for major and minor faci]ities of 1 S hours per response, includutg time for
<br />reviewing insffuctions, 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, Pivi-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Cffice of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />~Qneral Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Penninee Nante/ivfarling A:Idr~ss (and facility name location, if different)," " Pzrmit NumFar," and "Cisoh~rga
<br />NurnL-er" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring P~ricJ"covered by form where indicated.
<br />4. Enter each "Parmnzter" as spcci6ed in monitoring requirements of permit.
<br />5. Enter "Sr rnplz iviszsnran~n("data fur each parameter w ,i. "~.u~x!iry" and ~u~r/i!}'" as specified in pcrtn~t '~Ir~; Jbz" is
<br />nor.nzlly arithmetic average (gco, retie aeeruga for h~c.crial peu-umetes; v"all ssnplr measurements For each par~ne:e:
<br />obtai,ted dw~ng "i•.:oniloring fa!;a"; ":11.,*~;;rtnn" any : fi;,i-,aar~'• ~ro ^cr,^ally es.rcr;e nigF aad :o~. ~*reasu:-u ~ u :,
<br />obtained d~!ring ".. •.oi!o,i;>„ F~,i~,.a". (Nvic is munici, als ~rilit secondary iratmnt ~:grrrcma-t: Leer 30-day e~e-ag~
<br />of s~ npic mca~rremerts under 'hr -,- gas, end entu* maxims n 7-dad ~vc:zge of sw-nple mcasuremcrts ohla ne d~ ri',g
<br />monitoring period under "i/.:uinurre.")
<br />5. Iit.c: "Prr,;:rt Fr~;n~ir_;:;_et" for cac'•t paramu,r wader "mac-:miN"4r' "~ra!i/)~"as s;tceifir: in pzr*niC.
<br />Z lia,L:, "Pry. 6x" dnCC numher of ~'emnle m~y,,c..-.rr duricg mcnitorng i:,:r:vd th .' c ,ccvd macinurr (tnd'or igim`rrun
<br />or7 .::y:~.~:'crage as aporoprir.te);termit r~quiranent "or each pen?nut_r. 'S^.urc, cntc~ "G'
<br />P. .: ..- "F'r~?;vn:;~ ,,f i,t_~!ysis" b.itit c, "~. r,FiJ .c_ :,:ors„ _.:~" (bct~d! fi-caucncy of sarp'~ng any ar&tysis :'scd du~hg
<br />mo~:.oring oeriv~) a.:d as "Ps;;u~~ kr;u,r?ra:i"sp~cif~cd in hcnn~~. (c.~. :. ~- '.Sni,"for con(inuo.a:rou'iuring, "I /7"
<br />fur une ,;ay ps •re:', "//j0":~-one dap pcr monii, "'i 70" for un.; dey pcr qua^:c:, c~c.)
<br />.:^:: "Sr,.t''' ?y~_"both as "S ~e~F le !.'~-:~:~,-~; t ~;,."(acual su~r.ni: iypn us_ii G;r ,:~ tr. ~ti:urirg pcricdj r _ ur "Fernii!
<br />Rr.ti,;r,;..~„!," (e.g. °.Y.er "Gr,l" fo- ind~vio~`.^' s,r*tp1.c, '7ti//~" ion 24-ita.u cev:pcsit[. °i~:,'"' for con?i,~cots
<br />monitoring, etc.)
<br />.0. \',rherc violsrons ofpu.-rnit rcquircmerls arc sporicd, att.dt s brcf e:;plan:..ion .a ~usc^bc cane end cc-cctivc ac'ion;:
<br />to he taken, Jtd reference cacti violation by date.
<br />11. ?f ".n discharge" occurs during monitoring period, emu ";~o Dachargd' across furs in t~:ec•_ of daia cnry.
<br />12. Enter "i~'~raJTilla ~,f F.zncir:zf ~rs.-u1n~ Gfj'i.r," with "Sigrr,!rvs cj Fnrt:i; _c! Erg-!rhr„ G1Ji.7- ojlzr;lr,.i__1
<br />figen[. ""Te4a~h ;dz IJumha ; "and 'DuL; " a[ bottom of form.
<br />i3. iviafl signed Report to Office(s) by gate(s) specified in permit. Retain copy for you- records.
<br />i4. iviore dctaited instructions for use of this Dissh~rge tifxiiro;ine h.'For! (C,LS~ form may be ob'ained from OfGcc(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C- ] 318; 40 C.F.R 125.27). Failure to report or failure to report truthfiilly can result i n
<br />civil penalties no[ 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 year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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