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I;'~:~j~~ryvork Re~.~:~~:ion 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 per response for some minor facilities, to 110 hours as an average per respense 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, searching existing data sources, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of information, including suggestie^ for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 Ni Street, S.W.
<br />Washington, I;C 20460; and to the Office of Information and Regulatoy Affaits, Office cf Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />I. if form has been partially completed by preprinting, disregazd instruction directed at entry of '.hat information already
<br />preprinted.
<br />2. Enter "Permittee Namz/tifsiling Address (and facility name/location, if different)," " Fznrrit N,~mher;' and "Discharge
<br />Nrrml'.tr" where indicated. (A separate form is required for each discharge)
<br />3. Enter dates beginning and editing "Mcnila-ing FerisJ" covered by form where indicated.
<br />4. Enter each "Fsram?1~r" as specked in monitoring requirements of permit.
<br />5. ..°.n[cr "Ssn!~Iz .1: ~ltur_rarat!"data fcr each parameter ,uJder "~ runtit~ "and ~iuaGtp" as specified in permit. "AvnM,ye" is
<br />-.nrrnrtly a,ithmc~ic al e~age (geoulc?ric as~crge for h: curicl parameter:,) of all sa~npl.: mersucr.lcnts for czch prmme~cr
<br />obl.iinfd 'urirg "tF,nir-.ring Fz,ir._I"; ".14~tia:nia" and ,.lhrinnon" are normally e;.numc high and loJV measure ncr's
<br />oiY;rr~.J dwing "1' ;,,., .i.;b Fsrk ±". (Nota to mua~c:;.vls c.ith secorda~;~ trea'rreni -.•cir.neme.nt: 'inter 30-day avir,:g•
<br />of ssm ; c ir,c°,tnfrrc. s uvdcr "A~„J 1~_,"and cnic mr;~mrrn 7-ds•, avrra;;: o's~~-r ~'c tncasursn.-nLs onL,incd iu:i,,;
<br />monitoring period under "ivlaxirumr.")
<br />G. En',.. "1=;,-,.,i! R •i:~i,.:ut_nt" :or each par. Hoer end.: '•;:r., 1i(' ", .. "w~tiry"as sp~ci ice `.n ~,_rrc~t.
<br />7. U'-d~:: "i.r, r:.t" ent.:r rumocr of s:nnpl: me.;.urm.,,t curing mon't::: ,- - ~~oc; !`'; r..ceed mrs.in.um ;un"'^~ ntir:~'~~~.,
<br />c ~-:;. y avciab•: rs . p;tropritite) pemti: nyuiremrtl for each pammftc.J'f gone, fate' "U"
<br />1;. °n.f: ., ';~r! cit" i:Ct', .. "C_p..l, .vi ~. rr. .,: •,11' a Y I ~ .. ~ ., ~,,. r, v
<br />_ ' (c 'z 'rogoe'-cy a", r.tl!r :^ ysis'.sc:~ c~v no
<br />mo ~itc~. t~ _rl:::) and as " ,:i: ,i-.,r-, ~,,: ,nr" s; , .::i„ri it i:cnidt (a.g. ~.clcr " '' ~Lr cor~;~~wou, moot r,;~,r„ "!/7"
<br />- nnc day ,]c. t. _ •! "%/30" fn err. day per rout'., "/~90" f;,r r ~ Jay par quar,e~, e._'.)
<br />~~-' "S~ ~.a- • T^- ' bot't .. "S_~.;F.L ,.._.~srr_ .._.. ' (. ~I~. ~I sae, p!c L; pe s fd dcr~ t~ ,;tn~ta rind ; cncil ~-._ : i "'_rai:
<br />(,~~~rir ,nla!," (cg. !:alcr "~,~,!i-" for ind•', ii;:~.' eanp'c, "74;! fcr 2d-hrr'r~co'nr,ositc, ""r"' far con ircous
<br />monilorng, etc.;
<br />It:. '."nl,ra YIG1C]nn5 oflJC~mit rCgU!ibnCilh i_iC!i~Ci;l'.', 31',aCa 8 il~Crf~ml2aJin'7 to LC:C'~hC C2U~.C Cnd CC CI"_J~'C iC'i0'l5
<br />to ba :a?ten, and reference each violation by date.
<br />1 t. If "nn diseirargc" o:rugs dr-ing mo~atnrng pario/. en.'r "~~o Diafher~~~" ccrrss form in ph ce ;;f o:.ra r ,; ~•.
<br />12 Enter ';~'.~mJTitl:• of A-i.J~iF ~! F*_ urivr :~j! ~.. 1•,,i!h ';Si~,r~lurz cf r'ri,;_ ;, ,l £.uarti~,_ I,'ffi_e; •~` Au!h,; is .1
<br />lK,nt ""Tzlrp;J~aai~!u,nhe:,"end "Cate"at bottom of form.
<br />13. blril signed Report to OfTicc(s) by data(s) specified in p=emit. Retain copy for your recants.
<br />14. Wore detailed instructions for use of this ! is_lurbz ,L1•,ni!•„-i.rb R._F-.rt (C'~~RJ form may be obtained fr.m O('ice(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is roquircd by law (33 U.S.C. 1318; SO C.F.R. 125.27). Failure to report or failure [o repo'[ truthfully can result in
<br />civil penaities 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 oot more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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