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~~:~~rwork Re~uctioa Act 1~lotic
<br />Publi c repoting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average ner 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 hours per response, including time for
<br />reviewing instructions, seazching existing data sources, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of inforrrlation, 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 />VJaslungton, BC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />~:~~ gpal Instructions
<br />] . if form has been partially completed by preprinting, disreganl instruction directed at entry of that information already
<br />preprinted.
<br />2. Tntcr "Pernritt~e N~nrd/Moiling Address (and facility name location, if different)," " Pznnit NnmFer," and "Discharge
<br />Nrrm!-.:r" where indicated. (A sepazate form is required for each discharge.)
<br />3. Lnter dates beginning and editing "McniforingPerirl"covered by form where indicated.
<br />4. Cntcr cacti °P~r'arnzl?)'" as specified in monitoring requirements of permit.
<br />5. P.nter "S un~/~ ,14a uu; zm~nt" data for each panrcetcr under "~u~nNt;~" and r2rrality" es specified in permit. Ar•erwa" is
<br />rcnnzlly anihmcrc arcrage (geometric avergc`or bactencl pnrmetcrs) of all sample mavuremeats for each paramct•.r
<br />obtained dur'~f "'~!'.iitOrlny PLi I:~"~ ri'1"UiL!nr" arl c' i. /iliigrp,!" a]'e nOT~r!!y C::iGlne ~11~, and 'Uw 17Ca5ni2 nen h,
<br />oblaincd do.i l~ "L•;•,,:~it.rina Period". (1~ntC to fn',Jl,~c~;;als \ri[h azccndcr}' trcatntcnl r ~~!ircmcrt: Fntcr 33-day avc•agc
<br />o. samr'e r-nc_;ure~ac~ls ender "Aver~,;_ "~rd ~-]icr -. ~~raun 7-day wrage o's~~r; :e mcasu-e-ncats obu incc ~ur::'g
<br />monitoring period under "lv;,rximum.")
<br />5. 'n'.-';2';r.~tRrn~i,~";1_at"'orea~hpamsttc:cr;~nde "L;•.ul~~."::n~"[:e.~lily"ass;_cii~•:iinr_r~,liT.
<br />7. ~adc.' "/lr., r\° entLi nnmbCr of ;a"n ;'~ r'.::a11iCRIf VI: ~~d,V~ il`r :U i0~ _ ,od :' &' e:C_ed '~awli 'lUr (a'](1~'Ui nlln~0 ilTn
<br />cc 7-d: y eve-age as ~; propriate) _mit r, ;: rc r:.nt for cac;] parnmc±~r. 'f ^orc, cnL ~ "0"
<br />8. =n' .r "Fr.e;r _, -~, •f ~,ulysi~" 6;,fl] a" °~~ ,.l_ ,1._..., _,,._•;,:.• (rer:;1 "ru uerey o.` s. ~~ pli,]g and ara!,•sis rsed. Lr~ .l,
<br />mC'71 t']i~ng 12ri U') sn: aS "Pd',. sir r~ Ri,'~r.' yr'" Snr Cil :d .P ra in! . (C ~ 'J.tCr '.. ,,.. ' i ' .,+ 1/
<br />o' Cnnt r]I1n:,S moo .crr•• 7"
<br />for on!: day f,cr \vice':, "1/30" for c~c dry ner mnntn, "!/90" for o~c day i,Lr gl~stc*, cts.)
<br />4. , ..., "S~~,'.- ' ~}'_ a .,,1 as 'S1,a~.1_ .., . s~r~ .,rr, •, ' (elral n: irrpl~: type osC~ dur;]~ man tor;rg per,oi) ar .. ac "F_, ,,;:r
<br />Rs:lcir~m-:u.' (e.g .°.n:c: "C1r-cF" for i,~d~t•id:al sar]n'_, °?d. P, r"or 24'~.s, cutr:nositc, ',\%." _`o- ccn+Suo,~
<br />monitoring, etc.)
<br />]0. F:^~cc violations of Pe~oit requi,-crnent, arc rr:oo^c~, attach a l;rir!'cxpt~ar.!ion ±u d: =a.be c~cee rn~ cc:.ectivc actions
<br />to be ~a!:cn, and reference Cacit vio!atior. by daft.
<br />!. Tf ~'io discharge" occ,:rs Suring n onitorinP pcrinl. color "?le Dircbargr" scross form in place ofda!a etiry~.
<br />12. F.ntcr "Nam.;/Title ,f !'rinc;rz! L~:°:u7r: Lff~.~r'' wilt "Si;7rz~hrre ~.f Fr•u:"if ~! F.r._rrt;va G~_•er of ArR(;roriz~
<br />lgent,""Taleplnn~A4rnr,;,•,"end "Tate"s[bonomnfform.
<br />:3. t:Ts l signed Report to Office(s) by date(s) s]ecified ~n ncrnit. Retain copy for your rn:ords.
<br />14. 1-tore detailed instructions for use of this Gis:,Sarg~ rL;r,;litor.'ng RF•,rt (D1vIR) form may be obtained iron OCfice(ti)
<br />specified in permit.
<br />Legal 1lTotice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Paihue to report or failure to report Wthfully 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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