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Paperwork Reduction Act Notice
<br />' Public repo Rine burden for this enllectinn of in fnrmafi nn a ?sti m,rPd t~ vary f,•~m c ra~gc ~sf ,~ hour. as vl
<br />• -•'`~b~ 1"" i,..,Yvuuv m: so:,:~ .idaw ;..~lldlcs, :U ; 10 uuurs cs e.r average per response tur some motor facilities,
<br />wish ,: +c.•ioh.l ~! e+•cr^.gc `cr mxjc: ~d nuuor !'acilitia; of iE Sour; p~: rspousc, LlLiudiog time for revlewmg
<br />instructions, searchieg existing data sources, gathering and maintaini,~g the dais nu:dcd, and compl~LnK and
<br />' reviewing the collection of mformatien. Send commenL•: regarding [he burden estimate or any other aspect of ~.
<br />this collection of information, mcludtng suggestions for reducing [his burden, to Chief, lnformation Policy i
<br />Br,.nch, Pht-223, US. ~nvironmeoal Pwta iuu i~gency, 401 M Street, SW Wa.,hinglun, DC 10460; and to the
<br />~ Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />L If form has been partially completed by preprinting, disregard instructions directed ai entry of that infa^+eron
<br />already preprinted.
<br />2. Enter "Permrtree .h'nme::l~1mlmg Address (and facility ttartteAocation, if diH'erenQ," "Pvrmir \4unber," and
<br />"Di:chnrg:• ,:5unbl~r" ahcrc indicated. (A separate fornt is required for each discharge.)
<br />3. Enlcr dales beginning and cndmK ",1funltrlnng !'ermd" covered by form where indicated.
<br />7. ~mcr ~a.:a '' Fcmm~•!:.-" as ;p_nf; c.: ;;, momtonng reyuirenteni, o(;l~; wlt.
<br />5. Chic. '::':,,,:lll: Sieu,uic;,l.nr" tiara for each parameter under ' ~hlorl!IM' and "(hrn_hn' !n units specified in pernut
<br />-h'cranc" is norma!!~; : ~thmatic a~ac;age (gcol:~elric :ncrage for bacterial parameters; of all sample nteasutentenls
<br />for each parameter obtained during ".1;nru:uring ":-~~%~.S', ",1lnrumurl" and ".'-!milmo.~" •{rc norntall} e.xtrentc high
<br />and lots mcasucmenls chtained during ".'Jonlluruli; Prrrud." (Note to municipals ttlth second:,; treatment
<br />rcquircmcnC Enter 30-dav avcrnr;c of smm~le m~'ncnm.*+enlc under " I vcrno~ " °od c^~^• ^asinn:r* 'i dap a:eragc
<br />of sample mcasuremcnis obutincd during monitoring pcr.od under "Afaximurn "/
<br />~. i tdC.- "i'i; ;n,i /1. y.urcmt'lli" fUl Call, pal allle0.i iii il..,: 'Qaalllul"and (7anlll L'" a5 5}7eellICL ll CErl rill.
<br />7. Under "A'o 1x" enter number of sample mcasurments dunni; mon~ioring period that exceed maximum (and/or
<br />minlmllm nr 7-dav aY?ra Cr• ac annrnnrinlrl nrrmil req+]IMT^^! f^• I"!~h ^^^..meter. If none, en!c• "n"
<br />....
<br />A Fmrr "4:n...,......,. ,.i I_..1,.~..~° F,^.b ..- :: c...^•~ :l, __ _, '" :I f:"' 'f ', ril .~,.- „ ,
<br />....... ...... ....,... ...,,,,.u~' a ..L, , rid
<br />during monitoring ~_:iod) ,rid as "Fermi! ticquiremtvl( specified in pcrntit (e.g., Enter "('riot," for ce:tr:nuous
<br />aait:EOring, "1!7" fcr on, ri;y F,._: •: ,.,.... "!'3G' far nnc ._~+s per momh. "I.90" fcr e~-•+~ d.tv per quarter. cic
<br />_. _. _... ~ ,, Y~ ,.. ...1 ,.. ..
<br />"Perlmr Regruremenr." (e. g., borer "Groh for mdieldual sample. "_'~/!(~"~Ib: 2a-hour composite. ".~''A"for
<br />COlltlnllnll5 mnnitnllno„ (,`if 1
<br />10. Where violations of permit requirements arc reported, attach a brief explanation to describe cause and correcGce
<br />actions lateen, and reference each violation b} date.
<br />11. If "no discharge" occurs during monitoring period, enter ".'1'o Discharge" across form in place of data emry
<br />l2. Enter "Name.~Tir(e ojPrrncipa! Esecu(IVe Officer" with "Signature ojFrincipnl Executive O~cer ojAufhorized
<br />Agent," "Telephone Number," and "Dale" at bottom of fornt.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afoniloring Report (D,LfRJ form maybe obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 13]8; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed 625,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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