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~~ ~..~.~~a~~rk Deduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours zs an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major
<br />f tcilities, with a weighted average for major and minor facilities of 18 hours per response, including tune for
<br />reviewing instructions, searching existing data sources, gathering and maintaiaing the data seeded, 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 />Vashington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />E udget, Washington, DC 20503.
<br />general Instructions
<br />I. If form has been partially completed by preprinting, disregard instruction detected at entry of that information already
<br />preprinted.
<br />2. Enter "Perminae Name/Nailing liddress (and facility name/location, if different)," "Permit Num5e1;" and "Discharga
<br />NumE~r' where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "ivloniroring Peric ~"covered by form where indicated.
<br />4. Enter each "Faromelsr" as specified in monitoring requirements of permit,
<br />5. Enter "SnnFl.; d1_~serra,nen r" data for etch parameter under "~uautiq~" an3 ~itraliq "as specified in permit. "A v.~ra~d" is
<br />norrtally arithmetic average (geometric average fur bacterial parameter) of all sample mes~rements for each parame~rr
<br />obtained during ".L/-.nirorino~ f,;,-iod'; "ir:r.i,:rr,o" ani i:dinimum" aze ^er:nally c>.Ircmc ~1igh and low rocasurc.rcnt,
<br />obteincd derinb ".!•t-,ni/'„ir,{ P~rva". Q~nte to municipals r~tir secoodnry trc~tmen; r.yoircmcnl: Rnt~~r 3C-d..y n~eagc
<br />or .n i~plc mca5urcrncn,s unr c* 'Ar~,Jg~,"and sate: ma::im~sr 7-d::} avace:: of sample mccsuremcnt+ obtained duri,:g
<br />monitoring period under ",Y;uimum.")
<br />('.. %l:.C'Pery./i~/i1~#ir'_'/i'_'dl"for eaC'paratr. c!Ci LndL'i ",rdaill.'r~"~^.V "~N,Jfi(j~°a55pCClfpd 'n pc,r. '1.
<br />7. lirdcr "i/': C.=" c^bT nurnbcr o"sample ~i~sserm: ~t dur;ng mnni,nr;•r~ ,.:rod iF,~t _>cccd ma•.in-um (aauior r„in'~nurn
<br />or i-a:y a. ~rege as ~p,~ropriate) permit renuin'mcr.t for each prrzr.,ctcr. 'f none, en _r "U"
<br />II. L , _ "I7d,v~ ~n_; •,fJ,r_s~s" bot~r as "S_-mp t ..._.u,r;,~;_,+!" (acturl -aquc~cy oc .z-rl' :g t;n( a~rlysis ,used rr• .~~
<br />moni;or~~rg period) a.td as "P_•n:n.'. R~ ~ri/vn,.~ni"spcc~Ted in pr.;~nit. (c.g. cn!c "iia~.',"for cont~r.uc s rroai?orirg, ':!r7"
<br />fur one c;a~ p:r wee`., "l/.10"for oae day pe; monti~, '7'90"for one dcy per yuaner, crc.)
<br />S, i:nt.r "S~;.f l~ 1}~ ~" hotlt as "c.,..;rl~ !SJr,~_•IV •r.,•" (actual sample typz ts.d dr>;ng ncnitor'ng ~e end; and as "~_'.f,ri~
<br />2aeirs.;r~ar," (e.g. :: i.er "GriF" for ;ndividucl satnplc, "1dH~" for 24-hour cwnposita, '~J/A" for cortirucus
<br />monitoring, etc.)
<br />]0. 1': acre violst'oos of ~:rmit re~uircments sic cportcd, of aci~ a brief c::pfznalioa to c:cs^_ribc cause rn5 comcctive z_ o^s
<br />to be taken, and reference each violation by date.
<br />1 1. Ir^,,-,o dis_harge" occurs during monitorro Herod, en'cr "`:e Discharge" across Corn: in place of data entry.
<br />1 Z. Enter "ilrrn;re/Tii!e of PrGrcir ~l 6~a.vlira G/!r_~, " rvi21, "Srb~~al.o,~ of Frin_. j,>•1 r rasutre Gfji:.er of Avtko. iz ~..f
<br />(gent, ""Tzlep%ronr Nmnhsr, "and "Cou" at bottom of Form.
<br />13. ivlail signed Aeport to Office(s) by date(s) specified in permit. Retain copy for your r~t;ords.
<br />]4. Adore detailed instructions for use of this Gisch~~s ,btoniloring 2F~rr (DlvffiJ form may ba obtained from OFlice(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 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. D3l99)
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