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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 hotus 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 />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 "Pznrrittza Name/Moiiing Address (and facility namellocation, if different)," "Permit Number," and "Discharge
<br />NumFar" 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 monitoring requirements of permit.
<br />5. Enter "Sarrpls Mtas:~rersrt"data for each parameter under "~itraniirl"and ~h!a/i0'" as specified in permit. "Awroge"is
<br />normally a~i0unetic average (geometric average for bzc7crial parameters) o°all sarantc n,casurements for cash para,netcr
<br />obtained during ",L7,ni[orirrg Par-iod'; "iv,',zsin, ucr" and 1/.iar,;,nnr" ore normally er.itcme high and low measuremunts
<br />obtz~neJ du-i. g '7;,uih„iag Period". (IVot: [o mimicipzls with secondar;~ trertmen; r~c;uirecent: ^rtcr 30-day averz~c
<br />of sample m:asoremc,ris under '9varag~,"and enter r-ra~:inu n 7-~c'~ :.v,rr~. o's ;; Ic ;neas~rmenh o~taincd dur~ g
<br />monitoring period under "iYlaxirrurr.")
<br />~. iru~r"PCI",JI~Re$~411i 11n_°i7/"for CACb parameter rndtr"CPJntll'"r.^d"L!'C+iii i~"SS bn.:C~iICd '~n l~lTnlt.
<br />7. ::-~~ ; "A'', /•'.-" r.rc - nu.mbcr of sample measuroroc ~' dring m.an~ic~'.~ - _ri:.c; ~.~,. • i..._c~: mua,-~,nm (a~~:u"r miu': ._n
<br />nr 7~':.y U'.., '.~~ a5 anr7rnp~latC) perinl if qni R::PC~:i fOC each t)ai a.ne:ei.Jlr n0:'l', , ^:cr "~".
<br />3. :=nter "Fr_~rr_r, y .j6;~ ~(}'sis"L•:;ih as "S!rrt,l_ l,-,' ,r,~,;r: "'ert__~ fr,:u,; cy c~ ~• Sri` „~nc; ana';sis used dwi~~g
<br />monitoin~perio) and as "Fcn,~%; Re.lrr6-,r,r~+,t"spccifi-d in pcnnit. (e.g.'-:nter'C~,,,,"fo: con±inueus rncaitodnp„ "//7"
<br />for one dzy per ace!:, "//30" for anc day pe: monlir, "1/90" far one dr_y per quar'~cr, elc.)
<br />9. ?ter "5~,;/:/z 7;E~"JOIh as "S.rnrple : •/_~sr,rr.;re.n ;"(ac:uat :, mplc h;~a , sed during ~nonitori tl; periei) .r~l as "°,:,,;ri;
<br />Rsgrtirenr_,d," (c.g. En:c,: "G.~_P" far i^dividurl s:.•*~nlc, "24lr=" fur 2•S-hcrr cor,rposile, ";;UA" for contineous
<br />monitoring, etc.)
<br />t0. \'r,re,a v~nlzticns of,no~ nit -equircmerts are rporiut, rl(rdr a brie"C.:p'n~cr an [n i :_: ibe cause rod co,-rcrGve actions
<br />to be taYen, and reference each violation by date.
<br />11. ""no discaargc" occurs during monitoring pc-:od, cn'_r'T.o r: sdi . _... ~. fi..r. ' _ . -,y„ c •'.y.
<br />12. -rate,- 'gy~nre/Ti[t. cf .^rincipa! Erg zr!irz G~_~r" ~rtb "Si~n_.~.:. •j "rLr_, .~ ._ -~!iv: G~_~,' oj.{u~'tsrs_1
<br />Agan[, ""TelepLo;u Nu;:rh::,"and "Dax" at bottom of form.
<br />13..v;a" signed Ret:or', to Cf. ice(s) by dates) specified io pe,~nit. Retain cc,~~~ for yoc~ ~ i:..
<br />14. ;~:ora r:ct~ilod instructions for use of this DrS~/r1,g.: i~; ,,ri!;:i;tg R;=„; ?','nTeJ :. ,~ m y be e`.t;` icd -:;a C~ ~_:;.)
<br />speci ied in permit.
<br />~~~~~ ~~~~L~:W
<br />'This report is required bylaw (33 U.S.C. ]318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully czn result in
<br />civil pena]ties 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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