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Palaerwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 houus as an
<br />average per response for some minor facilities, to 1 ]0 hours 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, 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. Environmental Protection Agency, 401 M Street, S.W.
<br />Vashington, 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. [f form has been partially completed by preprinting, disregazd instruction directed at entry of that information ah-eady
<br />preprinted.
<br />2. Enter "Pennittee Name/Mailing Address (and facility name location, if different)," "Permit Numher," and "Discharge
<br />Numl•~r' where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Sntcr "Sample ivfrasnrement"data for each parameter under "~lunrity" and Quolip'" as specifiec in permit. 'Avzrage" is
<br />ne,mally aritlrmet~c avernge (gz~metric average for bacterial parameters) of all sample measurements fcr each parameter
<br />obtained during "lvi.nin.riu~ F,~siod'; "7~laximcrm" and Min%unml" are normally e::Srcr!re high and low mcasurernenh
<br />cbta~ncd d~~ng "L101/l/Lring PGfaOd". (Rote to municipals ^~ith secondary treatm_ri rc'. i~;cmCnt: ~ntcr 30-day averz„e
<br />of camp e rrcasuremcats undo "Avz.-ada,"and enter ma::imum 7-day avz.~ge of ~,a - .le measurements obtrined dur . „
<br />moni.oring period under "Ivaxinrunr.")
<br />G. A t--':°_: .. %rlL;uirrme;7!"for each parameter tatdei "~irtJnltly°r.,d "~Ilahl~/"a5 s~1::e11~Ci 1'~ f.e*mlt.
<br />7. L:r~.-.~ ",. „ . L ~ umber of sample meal:~remer du ing ruonitnring F~*icd tbr.} e; recta mazimon (anc/cr mini. -._n
<br />o,' 7-; • y . ~'c,r.~z ~s ap?ropriate) permit requiremer i for each parameter. If no-ic, eet_ - "0".
<br />,~. : ~:cr ", . ~~'~fn~iysis" both os "S_n,+clz I~L.~s:,,•,,,r.•r:~" (ectuat 5occ~ncy rf sc t,~llrg a•d aaa'ysis ±sed Burin;;
<br />:T10-: ~. '. V,~ i, c.iud) air' 25 °Pdl'nl.'I Rz;.^rzn.;,rt"s,ec; tied in pe.-mit. (e.g. Enter "., . ,,, for CO n:~tlLOVS momlonng, "I /7"
<br />"or r ~ ~:. cL- y ,aer '.: ee!:, "1.i30"for one day per month, "1/90" for one day per gaar:cr, e. ~.)
<br />9. ?at.. '_. ,, ~ /_ T•t e" both as "S ~.n~l: ;~i=~s~'r ~nr.•r t" (actual sam le tyn_ rscd dnr'rg mo,,itor:n;; per cd) anu as "F. ~ „li.
<br />FT~•,•+n,~t.rr_,r',' (c.,. ~n:ar "G:ah" for iidividual sn~nplc, "14HC" for 24-hour ca~,asiic, 'S^rLN" for continuous
<br />monitoring, etc.)
<br />] 0. 1 ^rcrz r;nlrtic •:: u:`; cnnit , equi;emcnts rrc r:por'ed, attach a brief explanation !c i cr'r,:~c cause and c^ nctirc ,:c:ia^~
<br />to be h:':en, c-d reference each violation by date.
<br />] 1. '""no i isc'i, ;, " nccure. during monito~nc priod, cns_r "T;o C'schargc" aaress fcT~: [,, ; tzcc c~dzta c -~~y.
<br />1~. -n'cr "i?~.::aT-ate Ljr'rin,;i,:a! F_at_utiv,e Gffi:~r" with 'Sigma::err ojPria~;,~r ~ST•_::Irv: GfJi__,~ Lj".;nl11o.%.-.d
<br />,:gzn r, ""T ~1 ;n;lL, rr Nu,; rf ~ r, "and "Gatz" at bottom of farm.
<br />' 3. .~ si;,a:! I.a, cri [o O(`:ce(s) by catc(s; specified in pcnnit. Retain copy for yoe.'rc c:i s.
<br />'!. • c-e :eki'zd ins7uctions for use o` this Cis.:lule~r IL;.:ri!;r%ng R ;~:w-! (I'd11~ Fn m n-~y b: e',•nir.d f-on- CTc_(;;
<br />apecified in permit.
<br />This report is required by law (33 U.S.C. 131 g; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can result :c
<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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