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~~t~1~ir~~v~Y ~ Deduction Act Notice
<br />I=ublic reporting burden for this collection of information is estimated to vary from a range of 10 hottrs as an
<br />average per response for some minor facilities, to 1 ]0 hears as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 1 S hours pcr response, including tune 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 />Cbief, L-tformation Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.Vit.
<br />\xtashingion, DC 20460; and to the Oi'~ice 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. Enter "Pe.zriltee NamehYioilina A:/dress (and facility name location, if different)," " Farmit Numher," and "Disch~rg,.~
<br />NumEer" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "1L;alil.rie~ Pcriu,l"covered by form where indicated.
<br />4. Enter ccch "Parar-.aet_r" as specified in monitoring requirements of permit.
<br />5. ~nicr "Sen, ply ivi_~slu•am~nt" dat.. for ccch parzn:eter under "eulnliQ "and qua/i!}'" as specified in permit. "Art,•,r~ ~" i~.
<br />normally arithmetic a`. r~ag~ (~~o,rc~,ic alerage fn; bacwial palemetcrs) oFall s.lirplc measuremen~s for each pa:amc er
<br />obtained dwi.~~ "bi~lrilsriae F_rF.J'; ",L,'ici;;na,l" and ;.(i;,imun!" ale nomlaliy e~ln_me high u.l] to ,• meas[n'cn,u:t~
<br />oLCainc] rtuiug ".'r,lri!.rirf; .jai' '" (T~ctu to munie~pais :~:i:h secondary trcatmrnt requircmcnt-. 1?n(cr 3G-day 2`.cra;;r
<br />of snnlple m•_escremerls under "~~.~ai_~,r," acci cats- ma:imrrn 7-dej ave:~gc ofss:r,p~c measwcmeai, obtained dcrvlg
<br />monitoring period under "1L%zrirrroll.")
<br />6. 3rve "P~i;.l%! i~•;~ril:•lizalil":or etch parameter under "Y;u..;u;t, ~"e.:d "rlrolily"ati spxificd in nclniL
<br />7. vCC~01 "I/•, F_:" :, ,,;- nural:cr of eanple mc~~•.~ ~::~ 1: i,,;;ng rnunituri r ::red tilt c>;cced may `mum (, -ld/nr lain -wa
<br />o~ ~-d::y,v..rage cs approp~el.,) perm;( reuui~cmc-ai fu,~ cacL pur.,mctc~: if r.nne, cnttr "t7".
<br />ti. 'n' „F.i'~ '1•_: _ .J_' Si f' bLLt ~ "G v.t rgp,rAd: ,lr•"~C~.Ila. 1' CLI _, Uf - .
<br />, v • ni "S- ~', ,; , s: n 'r.g . r.c;. an, i~•sis used c:.; iu;;
<br />'.a^ailor~,:G ptr.ui) ;.,d c_ "F.. •, u: R~r.,eir•„:dr,:"spccifici in p[ inn. (c.g.'".n!cr °_ ,: v,"f,:r confm_os rr ~n'[o,ing, "1~"
<br />ter ore ,ay pe vcc'[ "//3U" f~: one dam per moniL, "Ii70" fol ace da, pcr quare,-, z:c.)
<br />,. -i_: "S~ry!r?'•- 'Loth..' ,[ J_,:._... •~.n_,e!"(~ctuatsarn fjp~t;cddu_ 1;,:aoni.a;ic,;l:c~ud;an:;S"I_,n:%.
<br />1~~,•irc:;tslr," (.:,,, "..:c- "~~r_~/~•' icy inui~, idurl scmp4^, "?dH~" ;c'' 2C-;:cur co-nposilc, '~,Ll/L .' fUr conLinuoLs
<br />monitoring, etc.)
<br />1 G. 1. i7 CiC v]ulLii7nS Of ~ Cr,NI reCtll Cl'Te ;tti arc rc;:artc:': _t._ch z brcf C:.plana: /:n iG CGSCnLe Can SC and C'J r:2Ci:VC aG: L_`~ti
<br />to be takes, and rcfcrenee each violation by date.
<br />11. If"na disoharg,"occurs drying monitorng period, cn'tir "Nc Ciscoarg,:" across fore in phecc of daia cntT.
<br />1=. ~;n : "Na,.tJTirle ~j F,inci/~! I::'__~f!!L'. GfJG:'i" will; "Sig:±,;t~r: rf r,-ill.i/,! i~r_•_u!itf~ GLi__•r of Ate!:r;rc J
<br />.ie_i/t. ""T~i. F;l;lu A'u~nl-sr,"and "Eats" at bottom of form.
<br />13..via7 signed Report to Offcc(s) by date(s) specified ur permit. Retain copy for your records.
<br />:'ore detai!cu instructions for use of this Cisch.r,~d i~Aonita~;lr~ ReFu7 (~.L,7~ fo;ul may be obYairted 5nm OTice(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 131 S; 40 C.F.R. 125.27). Failwe to report or fai]ure to report trvthfiily 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 violatio4
<br />or by imprisonment for not more than one year, or both.
<br />£PA Form 3320-1 (Rev. 03/99)
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