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~L.:~~:_~~~~~ ~~ ~e~u^tion Act Noti^::,
<br />A
<br />Public reporting burden for this collection of information is estimated to vary from a range of ? 0 htrius as an
<br />average per response for some minor facilities, to ] ]0 hours as an average pcr response for some major
<br />facilities, with a weighted average for major and minor fzcilhies of 18 Lours pcr response, including iim~ for
<br />reviewing instructions, searching existing data sources, gathering and mai-t'.ainin~ the data needed, and
<br />completing and reviewing the collection of information, including suggestion for reducing this burden, to
<br />Chief, hifoartation Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />N/ashingtoa, BC 20460; and to the Ci;ice of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />general Instructions
<br />]. If farm has been partially completed by preprinting, disregazd instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/Ivlailing Address (and facility name location, if different)," "Perini! Numha•," and "Dischargz
<br />Numh~r" where indicated. (A separate form is required for each discharge.)
<br />3. Enier dates beginning and editing "Moeilorirte Pzrir.d" covered by form where indicated.
<br />4. Enter each "Pa; on, cur" as specified io monitoring requirements of pcmtit.
<br />5. Enter "Sampl.; N.:.~surznrent" date for each pamracter under "Quon{iry"&nd ~u~/%,~~" as specified in permit 'Ava;_gs" is
<br />~,o*mally arithmetic average (geometric aver „c for'„ncteriLl pa~ameturs) Ofell sample rneasurcmc,nts for cad; o: mrre~_r
<br />obtained during ":vl:a%t;rinb~ /"~,-i;_l'; "bleri,~rl•r,;" end ,14inhnum" e.:u nnrlrz~ly L.::r~uc sigh and low r~easure•ncnts
<br />O~7t31itC(~: GLL'lno "i ~'.L II'iY{Ab' Prri'. J". (Tt nt~ IC u.S~!L'illalS Fi''1 0.COndaiy LTL'aLiTIL'^' ~:;u.iLIDC^. is ^ntCi 30-day evcrJga
<br />Of sam nle in _c tiLICm6''=~ lln Ger '~~;':'.'r'~~_,"ECIi Cnllr ri ; nIIP LLn ~-d,y ~\'l.daC Cf SJni7IC mCrSll r~Pt_1 i5 Ot)l=,inCG dn7°^g
<br />mcni'oring period under ";v~acim.~rr..")
<br />6. °n'cr"P.~,,;+i!2./airs{nznr""o-eachpa~amcie,'mul~r";.u_rrih'"a-,~"~;~.!iey"as•~:ucitiedinrc:-ait.
<br />7. Ur der "/,'•, Fr" enter cumber o'sa,rple rncasur~+ne' ' c .- ~ Iron'. ~~n~ r_noc: C .r:_cl ma;;+nw 7 !end;nr ntin' -cm
<br />er 5~ dcy avcrLgu as y.~roprale) n_nni, m: ~:.~anent lur each ;mere-. tf no-~:, c~ '~.- "0".
<br />G. :n'_- "F~ ,~•za; -.f..vl~•s%e' cu, z= "S_,.. {_• .vLvc,~, ,.. ,~~" (, ct.ecl "n.c ~ -1ir~ r n1 a,e'ysis rscd d.neg
<br />munila{ ~lg reriaL) an6 : s "^s.,..a R:.,r~;,.,,-,~r•" - ci~~G in µ r:'' (,•.g. i~•u_ ~ . , ' ~Lr cc~r%~~Ja: s moniic,ting, "I/7„
<br />i77 nne day per a•ce:., "l/3U" for ene c;•r, ;,t~ n:-n"~, "Ir90" fnr on.. day f.s yuaCi ~. r•I;.)
<br />9. ?Hier "S ,;.F'l, Tse"bo~'a 2=: ",P.a,{FL ; . ~.~s;~,-t,.cc:" (..'_t'.ol s.:nplc tyic scd do!."^ mn,,~tc~ing nL:icc7 ans rs "I~rr,,,r;
<br />R.:;r~i•r+aa-c" (c.;;. '.ntcr ":~r•1/" fr,: %nciividuel sa,.n,;: "1''ir;" f{., ~y-'-.n ucn:lna",c, :.' fcr ccr~~ruut.
<br />monitoring, etc.)
<br />IC. !',~7=:r vicittions of pc,mit regt!ircrncnL or. rcpa4rd, a~i: c~~ 2 1-: i;;'.,.~4n Cin : '•i do ~^:br eau=.: and cnr'cc:i~'.: colons
<br />to Lc ta!cen, and refernce each violation by date.
<br />' 1. ?'".:o discharge" exurs de~irg mani:oriny i,erior, enter ".Jo Di=~har;;c" ccna::~.>r-~ i 11-~'~cu of ua~z i ~.,y.
<br />12. P.n.cr "N~:v/TilL of ,^ri%r:.i/-~l r:~.auils G~•_ ~.~ith ".Slyn~uo'~ r.; Fr, '' 1.;~_o,%r_ '%I;'' _, ~J ii{'~;~„'i___l
<br />Hbsnt, ""T~ I~pL Ana A{umL•rr, "and "G!z" at bat tom of form.
<br />13. :Jail signed Report to Oflicc(s) by date(s) specified in pc.mit. Retain copy for ym_~r rcords.
<br />14. Yorr, detailed instructions fo- use of this Gis:h.v~~ .ti.ni!ori;rg R.~'..'t (li/o-fltJ form may be ob:aircd from C~ce(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 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 year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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