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~~~~.~~rw®rl~ ~?~~€lnction Act Notice
<br />Public reporting burden for this collection of information is estimated to vzry from a. range of 10 bcw s as an
<br />average per response for some minor facilities, to 110 bows as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 18 bows 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 information, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, FiVf-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />4tlashingtoa, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />~erneral Instructions
<br />I. If form has been partially completed by preprinting, disregazd instruction directed at entry of that information aircady
<br />preprinted.
<br />2. Enier "Permittzz Name/Mailing Addrzss (and facility name/location, if different)," " Pzrmit NumBer," and "Dis.:hargz
<br />NumBer" where indicated. (A separate form is required for each dischazge.)
<br />3. );rater dates begirming and editing "Nfonitnri7rg Pe,icd" covered by form where indicated.
<br />4. Lnter each "ParwndL•r" as specified in monitoring requirements of permit.
<br />5. `imer "Slatpla,'~Lasuns,;r°nt"daGz for each parameter under "C_.turtih~"and ~ualifj~"as spcciaeL in permit. "Ar~rl•5 ~" is
<br />nomrally arithmetic overage (geometric average for bacteral parameters) of all sample measuremert= for each parameter
<br />obtainer. du7i;:g ".1/:.:%!oring I'zrtoy", "t4~rirrrtrrt" rnd RDub,rznu" arc normally estr_~nc high and !on measurement:;
<br />obtai~eci dwirg ".' u7r~..i~!o P_r%;~". (T~'ote [o rnucicinals v,ith secondery trcatnJ=rat r~uircment: timer 30-day av age
<br />of sar~plc rreasure~~e~'s ondcr Av,rr{;:',"and utter nrx xum 7-day avcraac o~srY,:--'.. mr:asurc,-,.,na obtain, ~ dwinL
<br />monitoring period under ";~arimm, .")
<br />6. °n:r"I'd,„tit R,~; uirzrt.ar"`or each paramelcr undrr"yit!377ffM"5nd "~ii4:7f1!),"a5 S~7CCl ICd III ~.a Tll~_
<br />7. Und_r "" F'c" rn'a r'omb„r of sa ncle mca;uroment daring n~.c~~ t ink pcro_' ~ .~: e.c_e~i;r~rr~itum (and/or m~n~r-um
<br />..- "-dcy avc,-rgc rs r _,propricic) pc-rrtit root, r: moat' ,~ : ach ;ta-.vncicr. ' f nnr.c, cr.tcr "0"
<br />E. 'rnf_ r "i.I '7;:1~ ,lr~n_dpsr.: ' i-nth as `S.' V'. ~s ,.,,,_, I" (;.cn~f ~" ~ ~ ~t, ~G r
<br />-eyu.',:y n ~ ~ml n„ end an~. sis c:., d_cioo
<br />monitor ~" ;-et'od) rid as "/'. , ~;. is R.; t•i;gin y,r" s,;,_r,~f.ed in permit. {c.g. Lnf~" °~ „+/ " 10~ CGiiul7 Ul'S mURl:O [ln~, nlnn
<br />for auc avy pc~ r r..c: , "1/3D" for one ~ ~, per rrcntlJ, "IrvO" for on: dey per gw.*fer, etc.)
<br />S. °nf, r ";,rr,-rs T;, ' both as '~4~,nr!_ .... ~,t+. ,,,..1,7"' (o~L.:. sannlc 7~pc u~._d ~ uri i~ Tmni:ar,n„ pe;;od{ end as ","~,~ni!
<br />f4.'JCIPJit.'C:," (C.~. T.niC; "Gall"" for ,IPCti`:Idual S-rA Jt' "All ." for 2~r I'P1 CJnip USltf, ':,~'/f. ~r ^Or COrt+LGGili
<br />manitorin~, etc.)
<br />1C. `','ht~e violations ^f nerm~t require,,:n"s ire -cncY.e:;, s;tach a I•.-icf e::ptrnari~tn to dcaribr. cause and cem~tve actions
<br />to be taken, end reference each violation by daft.
<br />t t. ?°"r.n disc:Jage" o"curs du: ing monitnriag p~rrtd_ en;cr "CIO Dischorgc" ;.cross fo,m is p:ae:e ofdeta cnh}•.
<br />12. Emcr ",~'~rt_/Till' „f /rim; it ~1 b:rr_ufi:a G/J'_;r" with "Si,~tn[rr~ of % r;r •it.i Fo,;=„tive G>~~ v of ~;utho:izs~l
<br />ligznr,""Talz~kor: "!untEar,"and "Cara" at bottom of form.
<br />13. i'/•~1 signed Repot to Office(s) by da~~(s) specified in permit. Retaut copy for your records.
<br />I4. MMere detailed instructions for usr; of this Gr's:Jrm~a ttdmita~ing R~:v7 ,7: tIR) fo~n may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by [aw (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can restilt 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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