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~ Paperwork Reduction Act Notice - -1
<br />Public repofinQ burden for this collection of information is estimated [o vary from a range of 10 bourn as an i
<br />..
<br />.,.;; ~.. ...._- ! ::~ .:_n i_ ., .- .:.,:.:.- fa.~il.t.:-.. [:. ` I~ !. ....._ ~,ti e~^. e~era,.r prr re•no^:-_ :nr ~.n:nr nl;: ;::r facilities,
<br />b.. 1._. .... _... ,
<br />•;~frh a weirhtrai wet a^_a `or major ;.nd minor facilities of ?B hours per response., including hmc For reviewing
<br />instructions, searching czisting data sources, gethering and maintaining [he data needed, and completing and I
<br />reviewing [be colleciiu^ of infu!u,a[iou. Sond comments regarding [be b+!rden estimate nr any other aspect of
<br />I th!s collection of in fu!u!aiion, including suggestions far reducing Ills burden, to Chi"f, Information Pnl!cy
<br />3rnrtch, PM1T-Z23, U.S. Environmental Prntrction Aecncy, 401 M Street, SVJ ~rJashingtov, bC 20^,6Q and to the I,
<br />~, Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 2050]. ~
<br />i -- --- -- -- - - - - --- --- - - - - - --- ~
<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregard instructions directed et entry of that information
<br />already preprinted.
<br />2. Enter "Permirrer N'umr.;tlni6ng :1ddress (and facility name/location, if different)," "Permit Number." and
<br />"!?+schnrgc A'umhr"" where Indicated (A separate form is required for each discharge.)
<br />3. Enlcr dales Ia:ginuing and cndl;,g ".1luadnnn,!; 1'rnud" co~:crcd by form «n.,-rc indicv!ci
<br />4. Er.lcr L.~_ "l'rrranr•r:'r" ac ~-pcnficd !r, moniton,r.~ rrquirc!uCnts o(pcrm!t.
<br />' r!:aa ! ,~h fir` .. , .~ ~ ~
<br />S. Lnkr "4w+;p;. ~„aa rru.••,:: n! .. Cr _':.-.. p- ~mrcr unnrr (hmnnir' aad "Ouch Ci m woos ;p.Cdlc,, to per:a::.
<br />",1 yrrot?r" is nermal!y arithmetic average (geometric a~.;ragc for b:iclcrial parameters) of all sample measurements
<br />for each parameter obtained during ",IlnnirorrnR Prrh;d": ",tlarrmum" and ",tLntnnctu" arc normally esveme high
<br />and low measurements oblamcd dunng '.I lunl(onux Penud." (~lotc to ntumcip:ils w7th scwndar}' lrcahnenl
<br />requiremcne Enter 10-day average of sample mcasurcnunts under ".-Iveru,Qe," and enter maximum 7-day average
<br />of sample measurements obtaulcd dunug tnuuito!i ng pcrcd under "1Jca:muni. 'i
<br />L. ~ntcr "Pcr;r:;r kegv+rvm:'nf' for each paranlc!rr under "Oumui(r' and "Quohry" as specified in permit.
<br />'. Under "\'n fs" enter number of sample mcasurmcnts during monitoring period that exceed maximum (and,'cr
<br />mtmmum or 7-day average as appropriate) permit rcquirmcnt for each parame?cr. If nonr, enter "0"
<br />R Fn1rr "h rr,gn'nrl• ul :innivgs" bull! :u "" ' ,! r~^ ^ of cam ling and analysis used
<br />.,un+p+, .',i[~?Jiiiiv,(" (~C(t:^. ...qnC!!-_' -..p
<br />dnnng memtonng pcnod) and as "Pernur ltryulrcrorni' spcuflcd tr. p~rult lc g.. ~n;ct . um,' :ul _u!u!!~:~".,,
<br />:nonitorirg. "/ 7" for one da}' per week, "1.30" for one day per month, "I NO" for one day per quarter, etc.)
<br />n r:n.,., ^t'mm~/.. Tenn" hnth ac ".1'unmle,llruswen;rr.r tactual sau!pic i}pc used ~I!ring n-~onaorng pcrud) ~uu .~
<br />.ill( IUr L4-nOm t,01^ .. :+ .~.
<br />"Prrnnr Requlrernenl," (e. g., Enter "Grab" for n:d:~.!dual sample, ~'' pUanc, ~~'~ "" `-
<br />COnlinuOnS mnnttOring. CIC.)
<br />10. Where violations of pernut requirements are reponed, alluch a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by dart.
<br />t I. 1f "no discharge" occurs during monitoring penod, enter ".Vn Dt.ccharge" across form in place of data cntr}'.
<br />l2. Enter "Name//'irle ojPrincipal Executive Officer" with "S}gtmrur>u oJPrincipal tkecunve Officer oj,luthe'rize<I
<br />Agenr," "Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in perntil. Retain copy for your records.
<br />14. More detailed insWCtions for use of this D(scharge.4lonimring Report (D.L/R) form may be obtained Crom O6ice(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
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