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~=~~~-~~~r~>; ~e~~~ction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />troerage 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 1 S bouts 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 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 />Budget, Washington, DC 20503.
<br />general Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Ferrnittee Nanre/ivloiling Address (and facility name/location, if different)," " F~rmit Nurrter,° and "Discharge
<br />Nurntzr" where indicated. (A separate form is required for each dschage.)
<br />3. Enter dates beginning and editing 'Sl.onitcrina Period" covered by form where indicated.
<br />G. Enter each "Faralndr'r" as specified in monitoring requirements of permit.
<br />5. Enter Ssr;tp!e i.decrsw sn, enl"data for c-di parameter ureter "~uantily" wd -~ualil;•" as specif ed in permit. "Avrrcg: "is
<br />nornally arit]tmeuc a~•eragc (geometric average fer'ranzrial pzram.br~) of all s:r,ple measurements for each pa-ameter
<br />obtained du;i :g '7,i,nih.rAre F~ri•,d'; "d'~ri:.r^,.r" and :.ii„inuuu" arc normally c;armc h;gh and ioty measu:Y rust;
<br />obtained dn.irg ".'~;•,ni;•.,-ih.; Period". (idote In m ~n'c'naa will s_•canGsry trcarmcr' rci,u .-meat: L-r'~r 30-day zverage
<br />of sample mcasureme~~u under ": v~r~b=," a •d cater m~'im_: t 7-c: ~ av,-sbc of s^ n fe mc.a!re:Tenu obk~ned de.~i .g
<br />monitoring period under 'Sbi.zrinnan.")
<br />6. !:oicr "F;:r:a~~ R..:~rirenrn~" for eac~r petrrne:er und~.' "_.r~,r: ^ end "Or•aliry"zc sn~cired i~n parni'.
<br />7. Under „/do Fa" er._ n~~n:;cr o'sampi~ m_us_r_~ ~: : du:iag nu r~itor't[t r-cnccr dui :.:cetd ma;.irrum (: nd,'or m ~, ~:um
<br />Dr i-cicy av~ragc as ;.pl,ropria[c) p.Tilit n:quire:ne~1 for each ~: rrnet~:. Jf sane, crt_r "C"
<br />iG:~_: "F,_.~ a-•,• •~ ..n_rsrs ao.h c; 5..,:F'e ... •,~::_•r, ,.i ~:.Jra! ir~.,~:^; a :rnl;Png we arcry;,s "se a-~~r~
<br />,PCC1101 Ong ~ CiIDG~ aa^ c5 "F'. r!(G k_,.~rir~„r..r:"s,~_,:Ged in p~~in i!. ('..g. ?:ntrr ,.',~::., ,• for conl~ruo~s n;osi Luling, "1/i"
<br />far one day pci c: ce'c, "I/30" for one day pa, mon~n, 'ZOO" fo; one d.y pu quaker, cL:.)
<br />S. Entc; ":i,~x.FL• ij,Fz" butlr as "S~ar~l:. z+su; ~;;r.,u"(actual ;rmfic ty,~o usza dl~r,rg ^:alitD-utg r:c,iad) and es "~~~;;rir
<br />R;lrrirs„<eat." (e.g. ;=~,.cr "Gr~r" for intiiviuu_i ,u~tplr, "'mot;,:" for 24-Hour co~npsife, "itr/~:" for confmuous
<br />monitoring, etc.)
<br />' 0. \'Jberc violations of pcnai[ rcgc ramcm. ;Ire rpartr.4 ut[acit a bn.cf c::}h:n:,'.ion [o cescribe cause and ee recdve aatio,vs
<br />to be taken, and reference each violation by date.
<br />] I. If"no dschazge" occurs during monitoring period, eater "No Cisctlargr" across farm in place of data enry.
<br />12. ?n:er "iJwns/Titls of Frin,:iF~! F..' ~_uriv G~~ •~'" taiii "Si,;n-der. . j Fr~n_rj _:r Fsscvtiv~ O~~cer aj Aedrrn-iz,:d
<br />Fig3nt, ""Tzlzp;: ;ne Nennhzr, "and 'Tate" of bottom of form.
<br />13. iv:ail signed Report to Of ice(s) by sate(s) specified in permit. Retain copy fur your recur u.
<br />14. more detailed instructions for use of this Dis:h,rgs rYlorriroring R_I.r4 (D,i~i/ form may be obtained from OFfice(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 year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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