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~~,~ ~°wv~r~ ~~~ ~~:9;ion Act Notice
<br />Public mporting burden for this collection of infos,7ation is estimated to vary from a range of 1C haws ss an
<br />average 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 18 hours per response, including lime for
<br />reviewing instructions, searching existing data sowces, 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 />VJashington, 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. Lnter "Pzrmittee Name/ivbilina A//rers (and facility namellocation, if different)," "Permit Number," and "Discirarg~
<br />NumP ~!" where indicated. (A separate form is required for each discharge.)
<br />3. Snter dates beginning and editing 'hLf-.niroring Peri-j" covered by font where indicated.
<br />4, F,nter each "Pararrstrr" as specified in monitoring requirements of permit.
<br />5. toter "Ssrgrle ivL• zrrrrsrnsnt"data for each parzme!er under "Quvrtigr" aLd `hnl-n'" as specifies. in permit. "Aver~sr" is
<br />rornalty ari0tmctic cverage (gecrn.etric average for bacterial pnr.msteis) of all sample musmerttnls for each parnmr.~cr
<br />ob[aine~ during "ivk.:i!~rins /' rP_!"; "14_~.irnmu" and lvlir+%m.~uu" a-c nu~nally e:a amc Itigit and low mcasw~~'cnts
<br />ob[ainci dw;ng "i~•l;uir;i,;b Frri,J". (Vote to m: niripals tr:'i scccnoar)• lnatm.nt ~ :~ uirement: ':~.tcr 3Gday avr. age
<br />of sz,~nic mca,wemc ,t, under ".tiva-J6_•,"and enter ms ;mum 7-day avcra~c o. szn- ale measw-cme,nts cSt~incd d!~rirg
<br />mon;i~ring period under "iv;,zcimur,!.")
<br />J. fill': "i .',l~l:!/Z'./Nit: L'...'~,!" ~Or Ca CSI peramcter LLn dCf "i.1rNd11l'"r. _ "~i!!.ll!iy"a5 5~7CCIfi CG ll 6Lrmii.
<br />7. iln5~r ",.. F c" «:ntcr numhc. o's:nnolc nt~sur. ni n! doing n,or''.ir;r~ ^riu:' :al _ .c_.,d maxiracm (~ td/or atin'~;tura
<br />or 7 dam, avenge rs r,.vopn.IC) ;:c -mit requiremcni for Tacit par.m~ac.-. If none, cu.~r "G".
<br />G. o;- "h'r>;v ;r_•, j.',v(;•.r'• ' L-rt': ~s '" ,,, / ~ ~_ ~c.o -,,.: a~" (a.L~l frcrnrnc~ o' s.:mi-iing a~~! ona:'sis '. scd Burin;;
<br />nuni!u~i';;; ~r;cd) ~••~L. as ".! _,;.rh R ~;vir:;n.,,!" sncciGcc in n, qtr '. (e.g 1'r..cr "...,:!,";ur Conti ~vu. s i~,oni~ain" ";/7'.
<br />"c; nnc d;,y pe.-'v.;e'.:, "1/30" for cne c~_, i;e> mont7, ";/90" for ane day ~^r qua ter, c.c.)
<br />S. nt :. ":i ~,.~ !• T.T,"bo.a re "S_,ar!.e 5.. ~~;;,-:,;,.,d" (pct al samp',c i"pc sed during n,uniiming pc~io:) anu es ". _n;il:
<br />R•/r~ ;>~;tt,;t," (e.g. 'irate- "G,-ab" far inciivi~url ~::mnle, "~Qii ' for 2:-bov canpasite, ,':;~i" fer eaniiruous
<br />monitoring, etc.)
<br />10. '.. ,. .. ~r.ci: t~n11 of >termit ienuiremznts ar„ repored, alac't a h icy e~p'utatioa to sa.cwe cause and caTCC.ivc ec'~uas
<br />t:, b~ tahce, and reference each violation by da_e.
<br />t ~. '""no dischrr~•e" occurs doing munitoring pario'1 entry "'~~o C~izchsrge" ::cross fug ~. in place of ca4 envy.
<br />17_. Gn.cr '•.:'±mz/Ti l.r~ rf /'ri:r~it:::l ='`e„uti~= Gffi__~" with "Sir;;ratr'rz of frh; :it ~' l:,, _t~~i v: Qjr~~,' of Au!,'.'.,i .~/
<br />Age,!t, ""T21_ph.n~ A!un, br,;"and "L`ate" at bottom of form.
<br />t3. ~b'.ail signed Rrpnri [o Office(s) by date(s) specified in permit. Retain copy for yourrLccrds.
<br />14. 'rtoru detailed instructions for ese of this /-is, hsrb,t Ntoui!c,rirro R.F~:-! (C.,/IRJ fcr'tt may be obtained fmm Oliice(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by taw (33 U.S.C. 1318; 40 C.F.R. 125.2'n. 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 yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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