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<br />Public 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, with a weighted average for major and minor facilities of ] 8 hours per response, including time for
<br />reviewing instructions, seazching existing data sources, gathering and maintaining the dat<~l needed, and
<br />completing and reviewing the collection of infotnarion, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M S5-ect, S.W.
<br />Washington, DC 20450; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />~~eral Instructions
<br />1. if form bas been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pernri[rze N1mzGNaiiing Address (and facility name location, if different}," "Permit Number," and "I~is~harg,:
<br />Nunrhzr" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "ld,niror-inn Pzr-icd"covered by form where indicated.
<br />4. P_ntcr each 'Taram_Lr" as specified in monitoring requirements of permit.
<br />5. Cuter "S~rrpL> i/ lcurr,r+_;~t" dcta for each pa ~mfter under "'~um,!ity"arid Quality+" as specifiec' in pe:rnit, "Arr,~TS ~" is
<br />nom~a'ly arthmctic uvzrasc (;;cometric cvcrge for b~cteriel pai;;ntc'crs) of all sarnpl.: messuremeets for each parameizr
<br />cbla`ncd dur.,~ 'Sl! :;ih;in~ Pdri•,J"; ";<-:.tirarnl" end ;.lin%nun;l" a e nn ;Welly c;[rame 'till; and 'oc. rr casu•menfs
<br />nbil;ne~ dui,g ",.. nk;,~iao Fsri•.1". (A'ot. io nt..micir;tlti \•.iat eece-dar' lreatmcz' :r.ciremcni: Enter 30-dry ave'crtc
<br />ofst-anletca•:u~erne~":c:dcr',..:r_,~e."fndL~:i:' .r~`^.or..7-tiny ave~ageof:a~n;'cne.asun-n;nisi~tiinedduri,'b
<br />monitoring per;od under ";:•iazi„uu,f.")
<br />"
<br />J. "nl?"/, i,J!r /;',un. r Or EBC pa'ar?elCr LI1P:""~. _,.';r)•"n,t Cl ,%L(ll ~~' ZSS-LCI~rf.C :^7f1i4i._
<br />7. J-td[: "r :'.v F..:'' e`+a currh'-:Ifs^..,~ )'c rc.^'ui,: nc,' ^tr,t~ -. r Irir;. ,~~rr^d Pt, t r .coed rr::im.tm (:. -tier min4r.ur,+.
<br />e7~d~y::v~ra~zrsccprunriLtf),-,;mi[:r;,`.•e-t;ntf,rftcbp^.anrel_;. 'nonz,ec'er"J"
<br />8.°.,. _ r,F,-..,; .,, - ..~,rr: ,!,,•t'. : ot'i as "°_ . _.... _,,. ~I!" (:c(url frrr I~u c, n' .~ aping and analy:'
<br />s nscd d•~~r~~
<br />T OR'.'ati s~•g ~ ~i[vi\ ; r~r as ''; ...:i iL 4'i.-rr r,:a" rn~ "~~"cri i'r ; :.r"'. 'C ~ ;~n!2. ', i.n1 "~-err cool=. ~.uo~_s n-anitm ~n ~' "!/7„
<br />for one day ;,~ r. tee'.:, "!/30" fe- c.re day )l'(Inac h, "F 9C"for o-rc coy ps qaa ie., cb:.) y
<br />9. ~'e-'(;.„~r~_ •r,, "hrt`. rs "S~„rfl,r ,,.-. _. _,. •n'" (: a.+::i srn- :yj;L u•Pd du-inr~ ~r ~ri(o.-in~::r iod' one es'T";•,;.
<br />R'avi,-,,;~;,.•,'• rc.-~. "ntc'~ "',r~%:" fur irdivid:.al .._..-rpl- "',//~_°' 1'c 74-hnv- cu:rnostc, 'r;%i " for cortinroc':
<br />nottitoring, eta.)
<br />10. '.'."n_rr, vir.lrtiuns of permit recuirme-...:.. •evl•r:c:~, °'tfcit :~ h: ieJ e tplanatio:? is cseribe enure au% en-rcLGve actior"
<br />to be taken, ~~~ri refernce each violation by da'.:.
<br />I I. tf "no :iiseilerge" occurs du.cg rnnmtonrg p ~rinl crtzr "h!o ^ischargc" acrrss fo-rl ul place: of dat¢ corn;.
<br />12. En~,_r "N~;n,:/Tit(a rj /'rirtcir_+! P.~•.u;it ~ :/ ~'_,'" with "Si.~r~h~~~ cj ('ri,t_iF.' fz._,i1iv~ O~~T of dedv„%-sJ
<br />/feat, ""Telr/1(t~.c ~ Nu,abz: ; "and "Cst a" at bottom of form.
<br />13. iviail seemed Report to CfGcc(s) by date(s) s~ecifsd in xrmit. Retain copy for your records.
<br />IS. iVtcre detailed instructions for use of this f is ;51, s~ ;~1~„riro:ir+d RcF :,~ (CrLfR) form may L-c 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). 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 no[ more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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