Pa~~~-~,lvork I2eda~c~~ion Act Notlc
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 how•s 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, searching existing data sowces, 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, disregazd instruction directed at entry of that information already
<br />preprinted
<br />2. F,nter "Permirtee Name%Lloiling Address (and facility name location, if different)," " Pzrmi! Numb°r," 2nd "Dis.-hargz
<br />Numbz~' where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "lvfati(orino Perird"covered by forth where indicated.
<br />4. Enter each "Forama(rr" as specified in monitoring requirements of permit.
<br />5. Enter "Smr1L rt/•lxuraur~;r!"data for each parameter under "~rr~n!i!)~" ar~d z~u1li,,"as sp;;ci5cd in permit. ':lr:•r -~a" is
<br />comtally arithmetic average (geometric average ror bectnrict parameters) : f zll santnlc mcasu-eme~t~ for each para peter
<br />obtained during ".Ll;nirrin~ Pzri~.f" ",t4_.rirrum" c,td 1.1nri,uum" a-c ^armall}~ _.~it.:me aigh and :arc mcasur.mu~',
<br />obtainer du,~: tg ",L;-.ni!•,;i:r„ F_ri;l". ~?rite In mur.;cipals tvi:h :cco~td.try treaur~~nt r„cii emc~t: 6ntcr 30-da}' ace zge
<br />o"ycmnle mea.;t:remcat=. r,,~er "Ana: ,~a."ard ente--~ x~num 7-day acemgc ofsan;l: m:scrc~,;n's obtrnec' Curing
<br />monitoring period under ';Lluximmtr.")
<br />5.^.-.r.-';'zn:vrRr,~:ri~aore,rr•':oreachparancterund,_"Gtv,r!ih~"anc'"~%ru/ir,~"~s:;:,riic_npe~ti`.
<br />7. Jndcr "~;'; F..t" enter nu,nbs ofsampte mct~weme-t dsring re '.r,'im,; ;r ioc' :`_, _ e.rd marimam ('ndior nun~a-um
<br />or 7dzy ;.vere•^,. rs : pnropria[^.) pc:mit n;q~.rr~mcnt fcr each parameter. tf none, entc~ "0".
<br />~. n:cr ','';-r :rr_~: •.Jfi,;~lysis"both as "°~,;,-L ,.; ~.~:,_„-s,.!"(actucl ~cquere; ,.rrnlir~,.r.dara;si, set C_~ir;;
<br />moni~.or;ng~.,tioG)croas"P_,~,r Ivuvi,_,r,.o,!"spcrif~~dini:cni. (cg ,.,fc: ..~•. ~_~cnr`~n.o.r.rc.,ritoric~ "t/7"
<br />frr one day pur+~: c.'c, "1/30" for oae clay ~.cr month, "!/90" fcr un,, day per er.::rtu, clc)
<br />4. '-m= ".;~a•,-'_ T}•Fa"both as "S~,:r~l_ ;~;.•,..~, . _,.,~or" (act~_al ssmpl_ t}-, : us_d during;~,ri.;tr:ng -~: god; and as ','.,,.. .
<br />k•./,+irar,u;n," (e.d. ''ntcr ";,,vl" for i:~d?:id~ial sartplu, '24t'::" fc• 24-'to ~ comp:tsitu, 'S"/~t" fnr ccrri~:cv:
<br />monitoring, etc.)
<br />10. \:"t. re violrtieos of permit requirements arc e~rr:rd. aazch a h~ef c.:planetion to dz,eribe taus:: anc: cor,~cNvc cetrns
<br />to be taken, and reference each violation by date.
<br />1 t. rr"no discharge" occurs during monitcrnv period, enter "'~:o Di~chargr" across fn.mt in plnc- e."da+a entry.
<br />12. Enter "Narnz/Ti!!z cf Prin~lr_,1 Fx,=u!it.r ~/ji.rr" with "Sitin~!vr:~ cj ,"rin_;c_,r ,^:..cutiv !'.~.•a; ~f Atnfr,;~,'-:a±
<br />Akznt, ""Te/zplroaz Arm:rFa;,"aod "L~n ~" at bottom of form.
<br />13. Mail sgned Report to Office(s) by date(s) specified in permit. Retaut copy for yom records.
<br />14. More detailed instructions for use of this Gis:harga M~,nitrnine Rzpor7 (GA9RJ (non may be obtained from Ci"icc(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 13 ] 8; 40 C.F.R. 125.2'n. Failure to report or failure to report truthfully can result i^
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,060 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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