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~_i~x:~rwork Re~:~W~~~n pct Notice
<br />Public reporting Uurden for this collection of information is estimated to vary from a range of l 0 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some majo*
<br />facilities, with a weighted average for major and minor facilities of 18 hours per response, including time for
<br />reviewing instructions, searching existing data sources, gathering and maintaining the data neeued, 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, 40] M Street, S.W.
<br />Washington, );C 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, BC 20503.
<br />general Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted
<br />2. En[er "Perenirtee Name/,Ytoi/ing Addrzss (and facility name location, if different)," " Fzrmit Numher," and "Dis_hJrge
<br />Ne?mEer" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates begiruting and editing '7vlonita•ing Pzri<.J" covered by Form where indicated.
<br />4. Eater each "Furartezr:r" as specified in monitoring rcquirumcnts of permit.
<br />5. L-nter "S_•neplz %i: Jsen-z,nzn!" datz for etch parrmctcr under "fir?~??ri!~'"and ilualih "as cpeGified in pcnr it "Are,-osz"is
<br />normally a~titmer:c cvengc (ocaltet-ic average io: bac!erial parameters) Droll sa~n, le ~nc:suremcr~ts or czch parzm.r,c.r
<br />obtaineG da,-ing ",:i•.ni!•a•ino Izri•,J"; "d:~ti~.~en;?" and L;i::i,,m:r" are ncr:nafiy 4rncme. high and luw mcasu.emcu;,
<br />obtained ds irg "::i.~ritoriu~ ,^:ri•;:!". (Tdo~c to muaiclpals o. ith sccenda~~ tr:~:.t*r_ :I n:y;.iremen,: r,+c 30-dey a,~ ~ag
<br />of vcmplc merit:rem^_nis under ".4vz~1„e,"and cnt~ ~ ;u:ime<n 7-c;: y av..:~gc of s;:m~lc mcrsura?ncn's a~t~ine' d Sri; ;,
<br />me~titoting period under "i/rlxinvna.")
<br />6. l:n'Gr "F~-,.ilti::+t^r.en~n!" fm eec~t paramuerutd.~ "~ir.r;:rrr,"anei "[A<o!i7,"as specifieu in p:.cri'.
<br />7. Urucr "i:!~ ~_." enter nwn';a c"smtplG mc. _ „-. Ju-ing n~rni~c=~i", .~=-~ad llr l :.c,.ed mc1i~ um (: ne;;„r+~rin' cum
<br />or ;-Cry:_..rz~c,s ah,;ropriau) pcrm~; rceu~~~m~nt "i+r tac!t panunc:c~. fsm;e, calcr ",,
<br />8. ~n.:r "F. ~n~,' ~.j'v:;r_d;ccir" be it , s .._ rr, t_• .~.; n.:, _ , ..,r.' =u.al ire_ ucrcy o' ... ,l tg , nr ~a : ; sis cec c.+i
<br />~.•,: ,~ ,
<br />nor.: t;ar,ng i~enoL) anc~ rs P_~,,,:'~ , ~;.,i;~_~r,r •u, s;•.~c+Gcu ut nr rr. ,. (r..g ~-nb:r ,~~ "rc: cor..~ao!s u~'~n~,au•g, "!ii.,
<br />~:nr a: ~_ dr.y Der r: c_s, "1/30" :or one day p'.; mun'1t, "i; 90"far eu.: d.°.y per qua::ci, ~:_.)
<br />a ~r r'S_,,;.1-r 'rr•_"6othar:"5~+,,,!L~.,"_:rr.,-~,,::c~"(.clualsa~~f4t,iszt~_jGc..-i~;aon`.'orii.;:~rio~.')a,~as'F_,,;r:
<br />R (i'i)`:~,?Cdr." (C. r,•. :..l;Ci "(irl~"" iOr ~10!l'IC: ,1~1 SURI]iC, '-:'!~~' fOi 2i-i'GIL~ LOIt1~GS1L^, ~.%"' _Or CO1t~^LCL`ti
<br />monitoring, eic.)
<br />10. l'.'Ttcrc violrtions cf t,F:rt~t reui-cmene. r: raportre;, all~cit c bticr;,;pia~aticn u: ~escd'ue cau;~ aad G•:rre: `.ve cc:iu,:~
<br />to bG l4ken, and reference each violation ~y date.
<br />11. If"no discharge" occurs d: ring moni[cnng pe ie~, : ; :i "i+fo IIisc'uarge" across `ors i t ~lar,G of ~iaL: eriy.
<br />12. ];n.er "T!a,nz/Tidz -jfrinciFa! Es:=ttlirs G~_•~r" +vidt "Si~n~+c,: GJ` Ftinri/s! c"x,:crrlrv:: (J~czr f /u:5r..izaJ
<br />Agznt, ""Tz1zF5•..?z iVumFz; , "and 'Tatz" at bottom o C furtn.
<br />13. hail signed Report to Office(s) by date(s) spccifi~d in pcnuit. Retain copy For your rcoics.
<br />t<l. >"on detailed instructions for use of dais Gis:a?lrez id",nitorireg 2por! (/'ivr7~ fo>-n m:.y be oblaincd from Ot;ice(s)
<br />spcci Pied 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 truthfiilly 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 violatioq
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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