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S,y Y<i. ~t `f i •/x al "~vi i,.._:.a.1.. 1.._ tv <br />Public reporting burden for this collection of information is estimated to va-y from a range of 10 hours as az <br />average per response for some minor facilities, to 110 hours as an zverage per response for some majcr <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 sources, gathering and mainaining the rata needed, and <br />completing and reviewing the collection of information, including suggestion for reducing this burden, to <br />(thief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W. <br />Washington, DC 20460; and to the Office of Infotmation and Regulatory Affairs, Office of Management and <br />Eludget, Washington, DC 20503. <br />general Instructions <br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information aUcady <br />preprinted. <br />2. Enter "Fznnittzz Nume/AAvi/ing Addrzss (and facility name location, if difTerent)," " P2rmif NuwM~r," and "l~ischarg~ <br />Nun:l:ter" where indicated. (A separate farm is required for each dischazge.) <br />3. En[cr dates beginning and editing "Ivlorutci inb Pzr-10„/"covered by form where indicated. <br />~. Enter each "Pm~artetzr" as specified in monitoring requirements of permit. <br />5. °nter "S~mpls lv,'svsl~:•am_•:rt" d:.+i fcr each parar ctcr undr~ "!uvvity" and ~;u~tih+"as specified 'n pccuit. 'Av~•r~,q~"is <br />nu;ma~ly arithmetic a. cage (gecrneGiL; u!crge `or L-ac~arisl pa!amu:crs) of ali sample mecsvamePts for each parameter <br />obtained during "ii/',.lit~r%rto ('ai>.!"; "1!~rinurr,„" a~ld ivii,;i~rrnr" arc nnrrrall; ,...,~cme 'sigh and low mcasu~aments <br />obtainc:i dvrin~ "i':':nt;oriag f_ri>1". ('col: to run~c~~:.L~s Lri;l scconda*}' trcatrnc't cnircme~i: EnLr 30-day avc-agc <br />of Sample mC3SUICinCPiS L'P-f C: °~ilYi'h{"rnL LntfT "C ;7,i~4i" 7-ae" aJerage Of5^c T~1C mLa5ll fCr,l:nt5 Bbtalned dur,r(~, <br />mo'•i[criig period under "irlari,aum.") <br />5. En!_r"P~•nnit.&;Hire„r_.u"fo-cachparanctorund~, ",v,air•"unJ°n~li~~"aesn~ci5cd np~rr,i-. <br />7. Under "/'.'o E.-." enter; u-nber oFsr ,*.!~ c~c"ure~nen: dL.irg ~~.e ~',:. ir•; ,.tine' t'-:: e;,czeG mtv:i Horn ;a~d~cr rnin~~*'u~~' <br />orI-d<^yavc-aroas..,;propriatc)n-.rmitrcq-'~t?_atrarcac'1p;.ramctc:Jlfnu.c,evtc: "(%„ <br />?. Win.. ",'•; ~..;_a_~' •.f rum/paic" t;oCl as "`.', ;rL b•;: ;•.: -,•: °ar" (aclusl^,cyurrc~ u' ce nolin~ :, d analysis used ~.-,v~g <br />monirorng j.e:iuo) ans as "~~ •;l,lit R_;'•ir;~~, •n~" ccccii~cd in pan:~,it. (c.g. !_:n!c;~ '., „,." fc~> ca:+:nu~,a Tonilurir~ "V7" <br />fcr one day p..r ~•: =:.'~, "1/~0` for one day per mc~`Cl, "!!90"for orz day per quar'c-, cb.: ) <br />~. l:n:er "^,~.,'~ !_ TT'" L-otf- : "S::,uFL d,'_~-v+c~,.r>;r"(rttval s„IrI„. typ;: racd d.:-ice^. ~~~anif;riny pond) and as 'F:r„..; <br />Tsyerir~;;r~'t." (e.g. "ntrr ";;;~`h" fo indiridval ~:r,lp;c, "Z.!!~" fcr 7.4-hour composite, "A%_'' for CO°'mcO.rS <br />monitoring, etc.) <br />I ~. L ~rll2rd Vlol1t10n5 Of DCTTllii nlgnirC?r7 L^I~S u~'? rCnC'Cf, GttaCh a Ii;CF C;y`iic nf.1101 t0 d7: Crb7 cause and CCr'C°tIYC aCUOnS <br />to be taken, and reference each violation by date. <br />11. if "ao discharge" occurs during monitoring p;,riod. error "P7o Di`charge" ecruss fornL in pltcc oft<ta entry. <br />12. Winter ~L'amz/TiIL of Iri,`zc;~s! Fsz:urir~ G~ •'r" wit;l "Si.;,ntur~ ~.f i rin,:i! lr Frecmrtiv,t G~°icer of Aulh~.ria~J <br />Agent,""Tekph .rrz A'umFe:,"and "D~le" at bottom of form. <br />13. \'iai]'signed Report to Office(s) by date(s) specified in perati[. Retain copy for yo,u records. <br />14. More detailed instructions for use of Glis Gis.h.rry~~ .V,alito;ing R~F;rI (Ci~11~ form may be obtained from Office(s) <br />specified in permit. <br />Legal Notice <br />'Reis report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failLUe to report truthfully can result in <br />I:ivi] penalties not [o 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. 03N9) <br />