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1~~.;~ y~~wcrl~ ~~~ ~:~:cgion Act Notice
<br />?ublic reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major
<br />facilities, v~ith 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 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 Y Street, S.W.
<br />Washington, 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, disregazd instruction directed at tmhy of that information already
<br />preprinted.
<br />2. Enter "Fermitt~°e Name/Moili;tg Addra_ss (and facility name/location, if differed[)," "Permit Nmnbsr," and "Gischargr
<br />Nunrhzr" where indicated. (A sepazate form is required for each discharge.)
<br />3. Enter dates beginning and editing "rY:onitw-ing F~rir.f"covered by form where indicated.
<br />4. Enter each "Foranralzr" as specified in monitoring requirements of permit.
<br />5. Enter "S_t;tFL' i4~_tcure.aenl" Baia far each parameter under "~u~rrtitt•" ar.d ~ealitp" as specified in perm t. "Avzr:rde"is
<br />aor.nally a_ithmotic a~. c-ago (geomc!ric n~ enge fur bacterial paraureter) of all saciple measurements fog each parme'er
<br />obtained du~n~ "o-l.rri~ori.r6 Fria'; ",t1~i,atrra" and ,'.li,~i„wm" are normally extreme high a.nd log., measure:-!~~,;~
<br />obfa~ned d_i~~~ " 1F :rr•.r+;r;, f'•ri 1". (Note to munir Vials with secondary trca[mc~t r~nuirement: linter 30-d:~y ave ~ab~r,
<br />of r: rrplc mesa crn.nr~ under 'ar_:~bd,"and onto maximura 7-Gap ave!~ge of sample measurements abtained during
<br />moaitariag period tmdcr "ivi~zintma.")
<br />6. =n. - P~n.~L IL;=ir_rrsnt" for cacti parameter undo: "~rmtlit;~"and "[xali:y"as spcciFcd in peTn`'
<br />7. 'Jnr'ei "i•''..=." a.i.'r ~urni;cr oFsample ~'~c:s~~cr-cnI •.iurng ntaniioring r:rcd Lii°.~. ,;:,ccc.'. rnaxi+n•,m /r ndicr mir.',.rurn
<br />or i-J~y .~.a~rage as appropriate) pcn~': requirement i~r each para.•ntae. 1f mono, enter "0".
<br />Q. ~..- "Fit , rn=,• •~'r',._ •'+~%c" o~rt'! .;, ".i~m,~ _ • ;"s~sr. a:r_ r~" actual ;requenry of s ~:nplin~ r nd ann'psis dscc' d+!.r ~~b
<br />mnni'or;ng period) and r ","'r-nrr f. ~.t,r,._,.•tu:"sprcified in p.rn~t. (e.. ni= ~••r*t," fir ceniiauous mun~lo~r~, "//7"
<br />fc•r unc Gry p,:~ r,c_':, "1/~ 0" for ogre day per month, "7,'40" to: one day per quarte-, etc.)
<br />^.. - ; _. "d~.r,f '. '; _" br :1! as "5...,• le A;~~e-• r,n -r~;"(ac~e:t sun!p', typo us_d dur:n,g manitorin~ neiad` ao;; is "F:rrnit
<br />lie./r4_:.u.,~l." (~:.~ -.~.''.u' "Gra!-" for inuivid~aa simple, "1;/!~" fc 25-ua:~ conposire, ".+%A' :or cout~oucus
<br />mottitornp„ etc.)
<br />10. \:~acz ~riolUiu~s of permit ,~quirements a .: r~partcu, atach a brief c: planation :u dusaihc cause end ccmacive ac5ons
<br />to he taken, and rcfercnce each violation by date.
<br />1 I. If "nc disuU.^_rge" nxurs do.zng moaiturino period, co:cr "i•:u l:iscllioc" across for? in place of [iaia entry.
<br />12. °_n.e: '}\ra,;,_iTi'rz r,~ f~incila( F's~ 'urir_ !i~_'_, " wit)r Si~;rstvr, of Frin_•i;-~! c.e: _trliv~ Ojl9c•e,, of ~Sufh~;-iz_1
<br />fig~nr, ""TrleFdt ,nz it'utnl-zr, "and "L~ats" at bottom of foam.
<br />13. A~.ai] signed Report to Ofiice(s) by date(s) specified in permit. Retaut copy for your records.
<br />'.~;. Bore detailed instructions for use of this Guc/tare~ M,nitwLtg RaF~n (Din7~ fom 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). Faihtre 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 mote than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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