|
Paperwork Reduction 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 hoots 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 information, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Envirottmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If Form Las been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Penrittee Name/Moiling Address (and facility nameflocation, if ditFerent);' "Permit Number," and "Discharge
<br />Numb~i' where indicated. (A separate form is required for each dschazge.)
<br />3. Enter dates beginning and editing 'Monilcring Period" covered by form where indicated
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. °_nter "S~mpL ,Li ~ ~smamtnt"data for each parameter under "Qruntity"and Quoli,p" as specified in permit "Avg; ags" is
<br />normally an thmetic average (geometric average for bacteria] parameters) of all sample measuremen~s for each parameter
<br />ob':ained during ",Vio;ritoring Feriod'; "i~L,airruurr" and Ivlirrirauav" are normally extreme high and low mcasure~nents
<br />obta~nrd du-ing ".'•;o~ritori;rg Period". (I~'o:e to municipals ~:~itb secondary 'sealmc~rt reuircme rt: Enter 30-day average
<br />of sarplc in_cu~r~ments under 'Av~rnbs,"and eater rrazimun 7-day average of sr-plc measurements obtau ad durng
<br />monitoring period under "i/azirrum.")
<br />5. -.:c-'S^rr. i~,2.;~•t._„roar"fur each parameter+~ndar"pumr/ity"aad"nualiq,"asspeci°cdhperrri*.
<br />7. ;Jr z,~ "s'. °.: " : .~.~mSar o"sample merscrcmcn' doing mnnilor'n, ; =rood tt+a' a cal ~ v.imvm (un~'o- mint~~~ :~
<br />ar 7-~_y a~•; -~~: ae a ~prop,iate) pctmit rcquirament for each parameter. If none, entc~ "0".
<br />0. -Hier " ,. ;,•.a ,, ,~','„, ~i)•sis"both as ",S a;>,~L• ;~9~Jero-~rrt~,~r" (actca fT.accncy r,f r ~p1; ~ Ord an-'ysi, used c;u,L
<br />r~+.it.: in;;; :.ioi) a•.d rs "Ft:ruf R ;.r%re; . ,rt"specYed in n~nnit. (e.g. Enter "Cs..l,"fur ee'~~Fnuoue moniion~~g, "1 /7"
<br />";i nn.: day p.:r ~ r~~;!:, "//30" fo+ one day per month, "1/90" for one day p,;r quarter, c;c.)
<br />9. "'YZi "3_~.;,, !_ T•~F;:"both as "S~Jn,~7.• ;..r~~r"r~.na.r" (achial sample ty; c used due;*~ mcaito ~ t~ p^~ic,t) tr' ,., _,;ai!
<br />Ryq;:i,~er,t.r.ri." (:.;;. i~:ra' ":i :'F" for iadividu^1 sample, "19H.~" for 24-hour c.~-::po:.i;.~, ";'/A" iar ce~. ~;,iuous
<br />monitoring, etc.) -
<br />t0, \'rtcrc e'nl, ~iur, o: Lermit c,ri~e*ients arc reror'cd, ~•(tacS a brief c.;p!ana['m~ tc ,'cee:ib;. c°c,e r rd conrc:i~•c .:c[~.~ns
<br />to be ta'.teo, a+~.~ reference each violation by date.
<br />11. !f"r.u ; .,_. ,;." nce: -s during monitoring period, cnt~r "T:o Cacharge" across fern i~: p+rc~ of date e„ry
<br />1~ ,,~+:r 'S~r~,.rof%. L• •g" "',i,r;iFal 1'x'_r+tiva G~jt_er" w1h 'Si;,nah:,_ of PrineiT..i ,.c_.'taivt G~`i_s: ry`drr;:n-_,z>
<br />~:g~:rr, ""Tui~p,4oas Nront~.•,"and "Date" at bottom of form.
<br />t 3. ,.a;~ sgn^] ? .; u t to C"ce(s) by ~L(s) speei~ied in permit. Retain copy for you; rrw-cs.
<br />.. ;•:'orz ~etzil~u ;rstnictiocs fu, usa e~frs Ctv_;u,g~ Msai1.,-i.tg R;r.;t !Cd./]~ fo~n rr.cy o0 obi<fn.d fray. Cii:r.e(~;
<br />specified in permit.
<br />This repor~ is requL~ed. by ]a•.v (33 U.S.C. 131 C; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can rzs_;: i:.
<br />civil gcr.alhes not [o exceed $10,000 per day of violation; or io criminal penalties not to exceed $25,000 per day of violatiun,
<br />or by imprisonment for not more than one year, or both.
<br />Z;PA Form 3320-1 (Elev. 03/99)
<br />
|