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Pa~~P~~/~;~ x~ ~.e~uction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of ]0 hours as an'
<br />average per response for some minor facilities, to 110 hours as an average per response for some mzjcr ~
<br />facilities, with a weighted average for major and minor facilities of 18 hours per response; including time fer
<br />reviewing instructions, searching existing data sources, gathering and mainaining the data needed, ands
<br />completing and reviewing the collection of information, including suggestion for reducing this burdc.~, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 4C1 M Street, S.VJ.
<br />Washington, DC X460; 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 beco partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pe:-mittee NomehNoi/ing Address (and facility name/location, if different)," " P217rf(t Number," and "Du_hsrge
<br />Nermher' where indicated. (A separate form is required for each discharge.)
<br />3. I;oter dates beginning and editing "idcuih.:-i;rb FerioJ"covered by form where indicated.
<br />4. Enter each "Pm-arrat ~-" as specified in monitoring requirements of permit.
<br />5. Entc "S~mpla ;/, _,zsur~,aant"data for each parame:cr under "l:ruud,7~"and ~nr~lih" a5 specified in acrmit. "Are rat; " is
<br />no*ma!ly ar,Grmctic a~ erage (geometric avcroe for i?actcral pcra~-~:e(cn) of all sample rneasvremc.~'s ;'ur :.adt pa~l-•i.aer
<br />nbtxincd dcri rg "; ~I•,., irs,-irtg P~•ri•.d". ".~.sirrrrnr" and J. Ji,;i..,,u„" a;c nom-W l1y ~.:u.;nc Ligh and rn'' measuremenlr
<br />017tai^eG dllTln(~' "nv~.l7%(li"!d~ /'dl'i': tn.'(~'OtC tG mllri~C irfl15 "/i+~~ tifCO ~CaI'y trCBiTnCni riijl`~!Cm Erlf ~a]4i 3~-dP)' a~C'c^•
<br />o`srmnle mcasu-emer~s ender "'/.v.•,-~,;=,"and emcr m&;:imum %-dap a~crapt n"scr;'c me2surcn~_nLS nbla6r.;d c!rn~~~
<br />monitoring period under "iviaximwrr.") y
<br />5. ?or-r'T~•:~„itR.r.?ni,,:,nsar""oreachpe•ameterund.r"~,r,rvrr,;"a.1'Ln.~l(t,~"ass,;zcifcd~nnr,Tit.
<br />%. ~ndrr "i:'c F, r" enter numbs of::a-plc measurement d. rirg r,c,.. ':r.r; ~.r,iod t ,.l ..._a ~ masimt•m (rnd/cr mir~ nor-
<br />i day avarag;; rs e,propriatc) ~_-mit rc~u`remen: nor each prr:n:eter. ;i non., cntu `0".
<br />C. r,~:. "Frc,r?,.p ~.f fnaysi:"+,ul'i _~ "~ • ,,!. !:".. , _,,,_•nr" (a~ttrl :~,-Cr trac, .~ 'ing r id a;mlycis ..crl c..,i~~~
<br />mor: tnr-g period) zn:i as ",^s .,;it,'2~;±•i;,,r: nt" sor~ciftd in pc.~.:a. ;c.~. `:rifer ' _ .,~,. ...~ co^.Cim,:os rro ;i:cr:r• , "t/7„
<br />fer one d.:y per e; ~c':, "//30" fer o-t_ t;ay per month, "1.'90" fo- um dcy per nuartcr, e:e.) u
<br />9. ,:~+~~ ';; ,;;~ ?s 'r,t =";;ot%f as ".5~,„vj !s i ;_..,::,•s„r-,u" (a_ical !,, ;~ple Type ~s~d i v ~n~ ru ilrnn,; ~,cicr,) end as ', .-.0,1'
<br />k r~r~ir~uls, ~:, (e.,. dater "G,~ah" for i~u1F-ii:ual s:•nplc, "7tli~" fer 3-,-5c~ ~ co:npasiie, '?:Yi:" fnr contirues
<br />monitoring, etc.)
<br />1C. `.','he e ; iolaticns of permit rcnuimments :re -crnrct?, ; «acii a l: ief e;:plana ien to d_scrihe cacse .rid cnrrcc:rvc actions
<br />to 6e taken, and reference eacU violation by da+c.
<br />t 1. If "no disd arge" occurs during munito-inE pero~ entry "~Io Diechargr" acmes fog in (dace of eat:, entry.
<br />12. F.nier "N~mJTit/r rf Princicol £s,nvit~a ~ffi_.r" t~ith ".C,f;~fu;ro•1 of ~r5r i/~' ;s,cmic= Off cu: ojriutl,~.,iz~J
<br />~:grnr, ""Te%phonz Numbe; ; "and "Csr,:" at bottom of form.
<br />i 3. Mail signed Report to 01-Ticc(s) by dztc(s) spcciflcd in permit. Retain copy For your records.
<br />l~. More detailed instructions for use of this Gisc;r~rga Trlmircring R ~sr! (I:I.72) form may be obtained fmm Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.P.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 mote than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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