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<br />~~'~~~~~~~ r=~ eduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range cf 10 hot!rs 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 ~~eighted average for major and minor facilities of 18 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 for reducing this burden, to
<br />Chief, Information Policy 9ranch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />1ashington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Iludget, Washington, DC 20503.
<br />General I~~~tructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/Idoiling Address (and facility name/Iccation, if different)," "Permit Ntnnb~r," and "Disrharg~
<br />Nunl('~r" where indicated. (A separate form is required for each discharge.)
<br />3. Enter daces beginning and editing "NLmitorirtg P2rir, 1"covered by form where indicated.
<br />h. F.n[cr each °FOl'Jmtdr2l"" as specified in monitoring requirements of permit.
<br />S. F.ntcr "S_onFle ir~~3suran~,d" data for each parameter under "Qaaurirr"and (_usliq~" as xpccificd in permit. ".t v_rJg,:"is
<br />r.omally a*ithmetic average (gcoroetric ar,ra~e far bacterial paratnc:en) atoll sample rt~~sw-cmcnts for each p:~~arrtctcr
<br />nblained during ";vn: itori,g f~;is~l"; ,,. ~,imm~a" end lVfinirnw,t" arc no:-na~ly c.a arc 'sigh and !o?+ measm.;a.nts
<br />obt3incc during '„r.nit~,i;ty; f.,is1". (Note to m.^`cipals with accond.7 treahnc•:r 1uireme:?t: L-ntc~ 3D-day avc age
<br />of sa -,nlc mcrsuremc -ts e,r:er ",4vsrvo_ "acd enter maximun 7-cin,• :;vcra~.; of sa*»:z mcse-en:nts oStained du ;r;;
<br />mo,utaring period under "iv;¢xinrua.")
<br />(•. °.n"cr';",~.7iri2a-;ui,-znr~.rt"rorezchpcramr.crund_-";,•~_•r+:_"o.n;l'„r.-•li;~"cc~:ci'c.l'nnctr:~i.
<br />7. Und~-~ "%J, F'r" en:cr nuni~cr of sa~-tplc rcas.~rer~rnf .'~ i,,F mon~ln~i~:;; ,'rd .'- i' ; .r_ed mu:.im~.n ~:r~d;nr mi: `.~ um.
<br />u .-d.y arereg,: cs cp~:roPrisir) j~.rrrtit r.:qui-mcnl fnr each par:•m~:e:. 'f ~ronc, :°.4- "0..
<br />C. =~~:er "Fi: ; ••,r^, '~`,f, ~1„rr,„ L-c~1-. cs `S_,.y.l '..r,l., s,.~rar" (.: e' .: :._orrc; ^" sr ,pli ~ ~i~ d rnal;sic .se•1 dmin~
<br />mo,~ilnring per'ncf) aaC as "P:,-„tit Ie_•-.+ir,.„~ ,.!"specil~ed in nr:~~.ii'. ~.r.f- ;i' ~. . -,ii,":~n: mnC,uous -uni'sri~~g, "//7"
<br />nnc da, pe r w. dr, "!/30'' fn* nne rlay ,,er month, "!/40" fnr cn~ d ,} ~ ~' yn,:„• , cc.)
<br />S. : r "S_~ny-C• Tj•~ -"butt; c.. "S.r„r ' • ,,, e.•r;~^ .• e~~+" (. r~l :, •mnl. ;~ zc _,. d du. i~ ~ m.r,i;o.~cg Hero::) arc: as "f_•n,ri'
<br />h;grirr:v.~t " (e.t;. ;inter "G-')-~!•" fu; ind~viduar ~: m I:. '7~iN:;" for "?4-tr..: c:ur,osilc, '^'//" for continuous
<br />monitoring, etc.)
<br />a0. !;bier violrlinns of term l requirements rro crnr~rler, attach a hrie~'~c~;nl„na~ion tr~ i.,c: the eanse and cr.nce;ive aclion+
<br />tc be token, and reference each ~~elalion by date.
<br />] t. I r"io dischargd' oxurs dr*inp, moni:unng period, c~.:_r "T'u Dird,ard:" an Otis Burn i-t ;;t;;ce of data cnc;•.
<br />]2. renter 'Nsrra/TiIL •,j friaciF~! Esr,utiv~ Gfj~_~,,• +.vifh "Sig,,iuo' n,~ p, ;, i,~ ~r F.a ~_;rr;r.• O~ji:er of fitttlr;ri?e,a
<br />fgrnr, ""T~l~ph.mz Nurn[~~r,"and "C~te"at bottom of form.
<br />I3. A.Rail signed Report to Ofricc(s) by date(s) specified :n p: trait. Retain copy for you records.
<br />14. More detailed instructions for use of this Gir_/rar,;t ,1-;w,iiorirtg R.:~-,;7 (Gii/f7) form nay be oL'taincd 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 i^
<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 thao one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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