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~a~ervv~r?~ ~~~~~-:~~~"on Act Notice
<br />i'ublic reporting burden for this collection of information is estimated to vary from a range of ] 0 hours as an
<br />average per response for some minor facilities, to 110 hours as an average pcr response for sonic major
<br />facilities, with a weighted average for major and minor facilities of 13 hours per response, including time for
<br />reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of information, including suggestion far reducing this burden, to
<br />C:iLef, 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 ivlanagement and
<br />Eludget, Washington, DC 20503.
<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregazd instruction directed at entry of [hat information already
<br />preprinted.
<br />2. 1/nter "Parmirlee Nome%Nailing Addrus (and facility name/location, if different)," " Pzrmit Number," and "Discharge
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Lnter dates begiruting and editing "M niroriug Period" covered by form where indicated.
<br />~. Enter each "Faramztzr" as specified in monitoring requirements of permit.
<br />5. inter "S~mplz 1/,~osur~•riz;u" data for each parameecr unc;er "~ulnti, "attd ~.ua/ih, "es specified it permit "Ar:r~{ ~" is
<br />racnahy zsl•rmetic cverago (geometric average for bacterial parameters) cf all santplc mczsurements for each pa'amdcr
<br />obtained dt i tg ",n:~+%!vrini; Fzriod'; ";vl~~:i+mun" tnd i In+irnrun" aye nontaliy esremc higi~ and iow mcbsu-~;ncn's
<br />obtainer during ",~,•.nit~„i.tb FzrioJ". (1~oCc :n m!arcipctls svi+`; secondary treatment ~..quiremett: Enter 30-day svaage
<br />of sanplc mcasuremanls un~er %~,zrl~„ "and crier ,n:.;iinum 7-d::y av~~age of.rm,,le mcas~acrn~ols obt+.inc~ G,~i,.(,
<br />monitoring period under '9ttiaximut>r.")
<br />C. ^ICr "i r..nir R~;uirz,rtza!" for each p;uac;_r u*td_' "`u.,.!ih "ac. "zrr~hly"as specified in rent''.
<br />7. Urdc. "+d~. F. r" enter nunber of sa -,plc m~_rnw emcm uninp. m~:Jl ..in, ;,cord : ~t ~ ,~c_d mar imum (:;~.c"t.r ,n'~~! -~u~n
<br />cr 7-d..y avenge is rppmn*i.,te) p.rrnit tey~iirem,n[ rnr c~ch p.nr:~md.ct. ;f ~~one, c l.; "7"
<br />f. La'e- "1-7~..•; '.r-~, rf r.',r~lj.sis" both as "S-~:. ; /_ ;..' • n.•,-.,., ~,;, •' (~d','_l Gin"•c._•• ,~f ~r.mtlinv .:n;i ?na ;~s~s sec' c; ring
<br />•' ,
<br />~~nuniwri~tg period) c-d as "Pa;;:it R_.tuir.rr,.•rr"spa:if,~d in ;-:anti;. (r,.g. Fntir "'s,rl," .e' coni~m as mcn$oric~, "I/7'.
<br />r.; one day p_r wcde, "!/30" fo- one day pcr month, "1:9!/" inr une day pcr yi~ar:er, cic.)
<br />S. Err: r ".5'. ,;:L)• T;;•-"both is "''~,+,t /_• 7.'• ,ru. ~+,~ •, .";r_u al ;,nnpl. type ~oeil during troy;faring ocred) ar.e'. us '! _,-„v r
<br />k'z./r+irzmeat," (e.g. Cnttr "Gui'~ for individucl _.~tiplc, "?1L':" fui 2u-Fo~.;r composite, ",r.„£" for carriruaus
<br />monitoring, etc.)
<br />10. ~:".•^ra violarovs cfpcrmif requirc;nene, era -eho ,cd, attach a l;rief explzn~tion to dzscribe carsc any cerru_li~,: actions
<br />to o:. taker., and reference each violation by date.
<br />] 1. If"no discharge" occur during menitorng period, ea'~r'T'o Disdtar~e" comas foTn in placo ofciati enlr}•.
<br />12. Ln~.r 'SV_+;ne/Ti!tz r,~ Frirr~i/ ~1 E-r :-ulird Gfj?:: • " wiU, "Sienale,•d cf Frn._ it..:! Lr ~.;iniv~ ril/ixr r f Aa•Ih~.r~-:J
<br />Agatt,""Tzleph~nzTlnmhzr,"and "Lutz"at bottom of form.
<br />13. ?ail signed :'report to O,'rice(s) by dale(s) specified in permit, Retain copy for your records.
<br />14. ~lorr, detailed instructions for use of [his Gis_ha,gz ivJsnirori+tg R<T;r! (Tiv1RJ forn may be obtained from O(iTre(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by iaw (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 unprisonment for not more tban one year, or bout.
<br />EPA Form 3320-1 (Rev. 03/99)
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