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~.,~:~rwork Re~nct~~~ Act Notice
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<br />~ Public reporting burden for this collection of information is estimated to vary frum a range of 10 hours as an
<br />average per response for some minor facilities, to ] ]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 />rl;viewing 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 />P/ashington, DC X460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Inst~-nctions
<br />t. If form has been partially completed by preprinting, disregazd instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pzrmin~~s Name/Mailing Address (and facility name location, if different)," " Parini! Number," and "DiscSiarga
<br />Numl-ar" where indicated. (A separate form is required foreach dischazge.)
<br />3. Enter dates beginning and editing "ionitoring Period" covered by form where indicated.
<br />4. Enter each "Faram~tar" as specified in monitoring requirements of permit.
<br />5. En[ar "SamFL ,+:J_•~sr;ra,a,:nl"data fur each paramete- under "lea:ui!}•"and Qnalit;," as specified in permit. "Av,•raor"is
<br />norrnally a-ithmetic ave,~ge (geometric overage for bacterial prrame,_rs) of all sample rneasureatents for eaci parameter
<br />obtained during "b lvr~tori,ro Period'; ",lherirrznn" ;mu i~Tiii,ii Jlil" a~'u ncnn 2liy crlnmc high and low measurcmcals
<br />obtained doing "br,nit;rind F„ri~.,+". Qdue ro nnm;c i,:ds wi'.h sucondap lrealment nGuirzmunt: l=ater 30-day awdZc
<br />of s:•_nplc measurements under "Avrsd.,"and enter ma::imtu-i 7-f_; r._r_ga of ec~nplc measurem:nt. obtained dorieU
<br />monitoring period under "i~iaximnm.")
<br />G. lin c. "Fa-rdi! R~~/rir~nn°vi"for caclr parameter undr "rJrm.,;., „~ni. " ;u~rli~~,"as zp;cifed in perrn~..
<br />7. under ",U.. Cs" e.r'~r nw~»er of sample m~_asurrrnr:~, dw-ing i~~onilurin~ ;+ ~:ud it•.: t c>.cc_d ma>_inurr (ard/or mb~rmm
<br />or I-day average v:. appropri~:e) pcnnii requirane~t far each p: uincvs. !Inunu, cd.r "0"
<br />P. cm.c' "Frr.~r-~r.y -f~ira!)~si,"both s "5~,;~,-L .:•;: ~~•,~.;;;•,,~' •.clL•~! f*cyu_oc; o,-:,_,;ding cnc, anal•~sis .see ~.i~~r;
<br />mcc'foring per:ndj er;,i as "f~_,-o~irk::?r~ir;,,.,:^."s;-•c.•ifi~d in pc :w. (r.g. ~nCCr'.,,.,! ";n-corrm.o_s:^,ai~torn~, "!r"
<br />fGr u-~e day pct e. ~:!:, "I/j0" fu: one day pc: moetli, "1.r7J" fur env duy per quarter, ere.)
<br />S. F.n'~: r "S~„ ~ L 7)F.:" bona e "S_~,,,~1: ,~_ ~r,::,,;~_,,:" (ec[ual si:m nl., i)•;:z ~s_d due ;~~ mr.-i-oring pcried~ any as "F -, v,iir
<br />F~7r•._„f.:a4" (e.g. c.~~er "(11']i'" for u,dvid~~,l sa~iplo, "7yii.." fc: 24=ague x~npositc, ",1'/,'" far continuous
<br />monitoring, etc.)
<br />0. CJhem ricl.aior~ of Via-: nil requirements era r.:poricd, aru,cS ;: Sref c::plr.catio^ :c descr:L•e c. use a.rd ee.Tective ac3oas
<br />to be tsken, and reference each violation by date.
<br />1 I. i. "no discharge" occu s d,ring monitoring period, cn~cr "i•lo T; scharge" across for.:; in pLce of daa entry.
<br />l7. iintc,- "ida,;,_/Tirl~ cJ h,rnciTll Err, urr.~ G~k_, " rvidt "Srrr_nur: •J` F-r',;_%i~1' F~e_irtii~: Gfj7_t; ref AutF.,~ized
<br />Agent, ""TeleF': ;v ~ A'nmha-, "and "rates " at bottom o f form.
<br />13. i/ai] signed Repert to Office(s) by date(s) specified in permit. Retain copy for your racords.
<br />'<i, ;viore dclailed instructions for use of [his Cischarg.: d/~niro, org RF~r7 (Gl•,RJ fonu may he obtained from Ofiicc(s)
<br />specified in permit.
<br />Legal Notice
<br />This ncport is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report trutnfully can result 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 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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