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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 hotus 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 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. 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 duetted at entry of that information aUeady
<br />preprinted.
<br />2. Enter "Permittze Name/Mailing Address (and facility name/location, if different)," " P~rmil Ni!mFer," and "Drschargz
<br />N!rmFer" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Mo!ritoring Perio9" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "S~!nple ibiaasvrzrrr.!t"data for each parameter under "Quantity" and qua/iJ~-"as specified in pemvt. 'Avgraga" is
<br />normally arithmetic average (~comelric average fnr ba~arial parameters) of all sarnplr mcasmements fu; each patzmeie,
<br />obtained during ":~f~nil.ring Parie,j"; "i~;aiiru•m" and Idini~aam" arc nomta'ly extreme high and loro measturmen's
<br />obtained dining "i„nircring ,°_risJ". (1`iote [o municipa's with secondary truttncnt ic.;ii e~aeat: 'inter 3Gday a~~erage
<br />of sample mcnsurcmcnts under "Av_rad~,"and enter maxims„ 7-say wcra;,--~ o:"rr-Hole rrcrs~rc:nents obtained doing
<br />monitoring period under "A'luimr!m.")
<br />G. Erter"F~n.!%r2nvirem:at"forc2cbparamcterundcr"~vnniir~",.:;d"~~•;,~I~t~~"assn~cifier',.l,zrmi
<br />7. Urger "N'. r-." ert_r nv~abcr cf s°.mple measoreme~t d~iring moniicr~„ :-' fi.t c ~_,.. ... ,.-; (_n4'or runi~.nwr
<br />o; 7-i.~y average as aipropriatc) pemit rerluiremert for oath parameter. I`no,c, a, „ .
<br />°~. ;inter "l:.rurn_}' :;`.:n,l~•.cis"bo'h as "S.+mi /a //,vs„r,:~,~r ,"'actor' fr;,r,~:ac, if. . of -;; ~„v e.-r•';sic ^sed dining
<br />moritn~ng po~os) a d as "Frr,;rii R:; r+rr_,,anr" s~ ca~fied in p.:rnut. (e.~. Fnirr ' .•.., ;" fn ~ co :i,irom mcniiorin;;, "1/7"
<br />for o.~,; r;cy per.:'a:':, '7/30" for one day pc month, "//90" for one day l:cr quarter, eta.)
<br />9. ?ntc: "S~n,Ela Tire"both as 'S ~rr,~!_ ; r°~~r ,-a;,:~~ ;" (~ciual sampl;; t, -a rsr 1 c;: , ;r„ -~:nn`o:=.rg l.c icr'; rr' as " :Hair
<br />R~:/rri.-_u7_~il," (e.g. Ent_~ ";i;-.rP" for i,rdividual sample, "2d1/C" fo, 2~-1-.-~~r rnnp;:~.ite, ",,?/~" fe: cu '~~inas
<br />monitoring, etc.)
<br />10. Plher vinle:iuns of permit regL'-cncnts are sported, attach a hiefc:n4rnr.''n-. _. _,,;_ _, -. ,. ~ :d conr u'~•c ..ct'.n:.
<br />[o be G^.'.ren, and reference each violation by date.
<br />] I. tf"ro dis_'r ;rl,o" occi~s during manitv:ing period, enttr'T:o C~scli. r2~~" ~.,,. _, i .m ' .. ~ _ , ;•.
<br />12. °ntcr "it!~nrc+Ti,le cf J'rin_iFa/ F,.r~~utiv.~ G~_'~'r" ~oith ",Si~;n4•., ~.f ~~~:~;:_; ' - _ _ ~~° ., '~`~'.~i4w:as1
<br />Agent, ""T~L•p;!c;ra A'uaiEsr, "and "Date " at bottom of form.
<br />13. ,Mail s~o ed Re a~ to C'";ce(s) by datc(s; speci5od in permit. Retain copy fcr; e~ ~. ca ter.
<br />'4. i:~!ore detail;,d instructions for use of this Gis_l~arga !L;ni!c~iag R;~,;.' ~r":.T) '~. ., i °; ... . _: '':-, .. -'
<br />--~'~
<br />specified in permit.
<br />ILW~~Il I`~I©~z^~
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R 125.2T. Failure to report or failure to report tmthfully can rut~~l[ 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 viola~on,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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