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°~=~~erwark eduction Act l~Totice
<br />Public repo:~ing bw den for ibis collection of information is estimated to vary from a range of 10 hours as 2n
<br />average per response for some minor facilities, to 110 hours as an average per response for some major
<br />facilities, with a weighted averagz 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 suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. F,nvironmental Protection Agency, 40l M Street, S.W.
<br />Rtashington, DC 20460; and to the Cffice of Information and Regulatory Affairs, OfSce of Management and
<br />Budget, Washington, DC 20503.
<br />~e~e~°~.l ~n~tructions
<br />]. If form has been partially completed by preprinting, dismgard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Fe/7rlirtes Nlm~/iviai!!xg .4~~ress (and facility naroe,'location, if different)," " Permrt Numl~r," and "Pischorg~
<br />Nnrr,Eer" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "ivionitorinb Pericl" covered by form where indicated
<br />~. Enter each "P~rameter" as specified in monitoring requirements of permit.
<br />5. 13ntrr ".S~,r.Fla ivcJSUrvriz/rt"dots for each pa*amctcr order "~trJnti.y" aid ~h%.:/i1p"as specified in permit. "Afrr.eee" is
<br />normally ai0lmetic average (gwcectric average fuC bea.erial ; arametcrs) mall sa'nple mcasu'emen[s Far each paraulcier
<br />Obtal,lC'd dl.fnla "~,n71111prl/lo JJl'l:~"( "hiJ L!1.7iLJ" ai1'i /.il: Jf.4lO,q" art IIOni'Ll1y eR~fCme .?Igh and iDW meaSUrCTIi)i5
<br />obtaiec~~ darrll~ ""-.,+lt~,rinF P~~~'.J". (1Jote Ll mtmiriras with sceonr'sry t~caimeai r.-yuir_mrnt: l'~ter 30-dcy accrage
<br />o°sample measuaements under ".: r:, 1,;;_,"and entc. maximu,n 7-uy zvcraga o''ssmple :rcastuemcnlc ohLined during
<br />monitoring period under "A~uimr!.n.")
<br />6. L.'. .- "/'e,-alit ~ ;~: ~ir_'1.:13t;t"fu; ca cil pzr2 n]o:cr lL1dCr "~Y7aJil,'~"r.nu "r,!:~ti ~)~"as cpCCiiic'~ in ~P,ITI ~,_
<br />7. li.tcer "i1o $r" ai.r vumSe~ u" sumpie m_~.• ur_-,en; uunng :n~:n~:ori-,g f ~:ct thai e~ecu; m:.n~rnum (2 ad!ur l;~inlT'?um
<br />or 7-day a.veia;e rs r; propr.~tr; pe,'n"! requirement fuf each par:netcr. tf ^o':o, cni,:r "0''.
<br />~~
<br />_inte~ ".^r~;re,c:p ~,f~ nllrrc" hoLh as o. m; r..., ~e'r_~ne-r!' ;i aril frc-;~_ lc; rf sort?I,'ing e^d anal}'sis .used dur;o;;
<br />monitoring ;lericL) a •~ as "/' -, rl ~c~-pvir,:,t _/.:"src:if ca ir. p..-^:iL (c.g. ,:ri~,, "~:,~r " lw con(inuocs ~r,uniia~i ;; "1/7"
<br />~u, one day jx . ~ , "L'3u" ,'o: oue day }..r month, '.!,%ll" :or cue gay per quartet, etc.)
<br />S. L-'nt_, '5J...t;L : j; 'foal as "S. ,n; t,. i~.._ .. ,-n_;:f.' (actuLl sumnt: typz us_j du*;ng No ti;nring p ) "
<br />eriod ._nd as r„li!
<br />It:.l.•+,~,,.te,.l." (..b. .L~ ". fl .'i " for individisl sanlpic, ")till,-" fc' 24-'~uur ~_omp^siU, ",1S'."" for con!inuuus
<br />monitoring, etc.)
<br />. .~. ~~r1irC "/1 O1EL1,^, .'ti Of ~.fSfnlt rCCiL'!iCP!CDIS a"c rCpOriL'L, ai.:1C11 p brief a::pia!?il:gin i0 CCSCIi17e CaaSa allri CO rreCLlVe 2CtiCnG
<br />to be taken, aru rcfererce each violation by date.
<br />t i. If' no disch~-ge" orL ~ s d",~iog r.;onitori:,~ pcricd, cl~cr "iJc I/~sch:*gc" :cross fnrn- in place o"data entry.
<br />I2. :intc,' iYxn_/Ti~J• of 1-.%u,;ir~! F~...i/ti'.~ ~i~r ~• " tvid~ "Siyv!~''ure ~,,r Frv;;:rt':! F_x_x~llv~ G~Ji~er of A17;lo,izad
<br />,4~~aa, ""TeLF,;.~,t;: A'nmh~r,"and "C~•tr" at bottom of form.
<br />13, i~.9ail signed Report to Offce(s) by date(s) specified in pemtit. Retain copy for your: eect~ls.
<br />:. iYiur^ detailea instructions for use o` t~.is Dis~hybt Lhnilc, iug R.pa~~ (~,f~ form may be eb~ained from Oi'Fice(s)
<br />specified in permit.
<br />Legal Notice
<br />:'his report is required by law (33 U.S.C. 13 ] 8; a0 C.F.R I Z5.27). Failure to report or failure to report truthfully can resull 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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