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1~m.~~~rwork Reduction tact NoticA
<br />Public reporting bwden for this collection of infomation is estimated to vary froth a range of 10 h~trs as an
<br />average per response for some minor facilities, to ] ]0 hours as an average per respvnse for some major
<br />facilities, with a weighted average for major and minor facilities of 13 hcurs per response, including time for
<br />reviewing instructions, searching existing data sources, gatheting and maintaining the data needed, aed
<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, 40i N Street, S.W.
<br />V/ashington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of P(lanagement and
<br />Eudget, Washington, DC 20503. ~
<br />general Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information aUeady
<br />preprinted.
<br />2. Enter "Fenniltee Name/fd~i!ing Address (and facility name location, if different)," " Pzrmit Number;' and "Dis.:harg~~
<br />Nunrb r' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Peri,J"covered by farm where indicated.
<br />4. Enter each 'Pa•arrst~r"as specified in monitoring requirements ofpcrmit.
<br />5. Enter "S1„rFlz .L,'s~sur~m.•ni" dzta for each paramc:cr under "Qu~~uii;," and ~irrl!it ~" as sr .rifled it permit. "Av •r ~~; e" is
<br />nennzlly arithmerc a.m. Jgc (geon~efie c, ~r_ge for':actr; e! pa~anNe-;) cf all sa,'.ph: ,-:easuremenls for each pa ~ - cc:
<br />obtained dr.ring "; v;.?irri»o Fs,r„y"; "1,'~:i,av,,;" and %iini:rx,n" arc ^o-mclt~~ ..:~n,nc high and tun mcasurr.7cots
<br />obtainer: during ",,,,nii•. i,,b P:•i. ~". (Vote to nun cin:.ls r.i ~ second:r)• Irenhnem u'r_mct::'n'cr ;0-day svrrage
<br />of 5;~;,'c ,ncrsu:cnurts ur.rter ",ti vs :•~ " a ~d entu ma'cimur 7-dr•• eve ,.;;e of yam ~Ie mesurem~.,~s obtained dirt;
<br />moniia,ing period under '7~: axi ,num.")
<br />G. I-:nlrr"Pr,;:virR2;'•"sm.ar!""ci uarhpaiamacrun?-. "LV~,:r%,, .-_t "(lr,G~;•"a=. ,=c',c~ in; nn':.
<br />7. C,~d.:i "i.'~, cr" er.ln cunbct oraample mccsurc~nrn, _,~ring n u-~'~.r'.,~. - .... ~ ..--! n~.-ir.um (cncJrr rttn:-~uo+.
<br />cr 7-,!,.y ave,egc rs ti,prup,iate) Emil requirem; iI nor etch pwam.::er.V i; ;?r-,, c ~e. "r"
<br />". ~:nl=- "t•~, s.(r•_,• ~ -r;f,u(yeis" boll, rs '.... -le .1i vcr,,~_,,,_ ,. ,, (. ~ ~ u~ ' •*
<br />c ~,. ",~°~uc: _~ 'v:rpl~n i ana _•s~~s use- nrnn~
<br />our:.or; to p,;~`od) end as "f'~,,,~it Rs,ui,-~„ .n," s;~ceil',ed f, r~i ,. (c.g. rfL ,. „ -err' ~c o,, ~ronitern„ 'r/"
<br />fcr one clay peg c: ~c:~ "(/j0" for a,c day ~;er mont•t, "r,n7" fo- n c r1-y ncr qun 1. i
<br />S. ^.,r: r "S.~c;, L• Ty; ' be7c, zs "S.,.irle ,i:;..,. -,.,_,i!" (~ ~a.~nl ..~~ pl: rc c~~d . -.:n~ m~ i. .gin,; n~ ) _ '
<br />fi•,v;,_,ar.~r,' (e.g. nf... "tJl.]i' ~o: ird~vidual .rrnt;l, '7d,..' frr 2~~Fo. c.,rio,il~-, '.'•::5(" :ar co~~r;,ucvs
<br />monitoring, etc.)
<br />l0. Cr",ere •riolc[irots o' aentit nc,ui .:mcn'r. ~c re~cr,e~, aliac'~ c l;r:c' c:p1r na(iu-, is d~:a'Sc cap :~ and cc active cc.iuns
<br />to S~ taken, and rcfc;ence each violation by date.
<br />' ]. 1"'no discharge" recurs dcricg mnnit~,;cg perod, cnt~r "1`:o Di~'d r, :gc" ccn: s [nor, i t I-.h:cc a. Gan cary.
<br />12. l:nw ",v-.»,z/rm, of P;irr~if~( F,rt:~u!irr Gj~-_, ' w1h "S,:y,,,tur~ c~' . , ,::i;~ H'.cs_:•rir: :r~i c: cy` ~ir:;r.,~ic_•_!
<br />f:g sat, ""Tslepl, ,;, r A4rm(vr, "and "Cars" at bottom of form.
<br />13. i\4ail signed Repot to O,Tice(a) by date(s) specified in permit. Retain copy ror you- rcccrds.
<br />14. A4ore detailed instructions for use of this /his=harbe ,Lf»ritorne Rat orr /Gb72/ form may be obtaiocd from Of;icc(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 rsult in
<br />civi t penalties no[ 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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