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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 hours as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 18 hotus 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 />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 has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permiltee Norne/Mailing Address (and facility name/location, if different)," " Parmit Number," and "Duch~rge
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in mouitoring requirements of permit.
<br />5. Enter "Sanrp(e Masurenent"data for eac'r parameter under "[iua:rriry" and Q:reli!)~" as specified in permit. 'Ava~•age" is
<br />normally arithmetic average (gcon;ctric averuge for buc:=ria1 paimnctc~) of all scnrplc measurements for eacb paramcte,-
<br />obtained during "rLtorrit~,ring Paiol'; ",11.t%r,rrra" and rir.;?,,::n;~" arr. vernall; e~~reme hig]• and low measurements
<br />obtained during "i~9:nir.,-iub P.rioJ". (P!et~ :o mt~ici*;els ~,~iC• s_condary trcr:r. unt %cquirement: ]inter 30-day average
<br />of sample measurements under 'iiv .~~~~,"end c~r_: r~aeim~n 7-c'r u•uc~a of s-n ac measurements obtained d_r~:;;
<br />monitoring period under "i/.azimum. ")
<br />6. E=nter"Pan.;i!Rr~nirrnr,tar"rorerchparame}e*unec "~r~:~nri;,"; ~"'~.rar%~j,"rsspecifiedinp;rmit.
<br />7. Cr c;cr "h'; F." enter nurnbzr u'sam~lc me. srr~r:a~ d,Ling n~oi~;f~.' _ iod tart c~ _ecd ma:<imum (encJc"r rziu? .gym
<br />or 7-day average as appropriate) pcrnit reyuir~mcr, °or each nor.:va~r.V1'~:oac, c .[-- "O".
<br />g. rotor "Frz7ne+ry cj.:rralysis" bollr as "S.~r.r/!. i:' ~~~.~:,,...." ;rah ~ ' _ ~: acy of s.-mpl~ag and analysis used doling
<br />monitorng period) and as "{~2i ,.!!! 1lZ ~i./'i C•1:.'. is"5'J~-.~1Cd Iri 7C iiL~. (t.' . ~niCi "~,61i," Cor continuous monitoring, "//7"
<br />for one day per wee!:, "//?0" fo- one day ner monti i, "//9t7"far one ~~, per quar;,r, etc.)
<br />9. °ntcr "S*nrt/a T,•,p~"~oth as "SanrrL /-i_.rsrm,:,u~r "(~~'usl =ample fy,-.c cs ~ dacng mo utoring period) and as ""a,-nrii
<br />R,tgui~erndnr," (e.g. EnL-r "G•_F" for i.:ui~~du_' gale, "~4:I'," fc 2~~-hour cornposite, "A//A" far continuous
<br />monitoring, etc.)
<br />10. \r/}rer. violations of ~enni[ :equirc,ncats aim renor ci, a ch r hr;~°r .'. _'',ia to Ccsc,ibc cause and corrective actions
<br />to be ta!:en, and reference each violation by date.
<br />11. If "no cisebarge" occurs during monito ing period, eY.. r ""r "'_ •'~ -;; .: ss foam .: place of da*a entry.
<br />12. 'inter "Name/Tidd rj T,-in::iFa! Fx~_utir~ G~j%.,.~" ~.~f:- "Sid;.. ., ~,f Pri:r:;i~,,! rrd_7•livz C~cer •.j Arrthorced
<br />Aganl, ""T~lepho+ra Nu,-.rhe:, "and "Late" at bottom o' fo ~,:.
<br />I3. lv:ail silimed Report to Of-eels) by c:~le(s; speci~c•' %o c,;nit. ^,e~ :'n r,; -• fur yu~~ ccords.
<br />14. More detailed instructions for ace of f~.is Dir_!r ~, - i.:•..~i!-.;i~r~ 4;- r, ;P,Y,72) 'irm may b; obtziced ;rom Cffce(s)
<br />specified in permit. u
<br />1.~~~c_:, w ~, ~.~~.~,
<br />This report is required by law (33 U.S.C. 1318; 40 C.~~.R 125.27).: ailure to report or failure to ncport truthfully can result it
<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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