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~'~I~erw®rk Reduc~•ion ~.ct l~Totict~;
<br />°ublic reporting burden for this collection o: information is estimated to vary from a range of 10 hours as an
<br />average Fer response for some minor facilities, tc 110 hcurs as an average per response for some major
<br />facilities, vlith a weighted average for major and minor facilities of 18 hours per response, including time for
<br />reviewing ins~'ttctions, 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. ~nvirortmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Cfiice of Information and Regulatory Affairs, Office of Management and
<br />Ludget, Washington, DC 20503.
<br />general Instructions
<br />1. If form has been partially completed by preprinting, disregard instmction directed at entry of that infcrmation akeady
<br />preprinted.
<br />2. Enter "Pelni![ee Name/d~loi/ing A~~drzss (and facility name location, if different)," " Pzrmir A'urnher," and "Dischs,ge
<br />Numt•e~' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "i1<a:ita-ing Perir„1"covered by forzn where indicated.
<br />4. Enter eacu "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "SorzL'k ki~.lstrrameir!" data for cacti pa:ametcr w~lc- "~u~rr'ity"end ~},'J/ih~" as specif ed in pem i;. 'Arer~a.•" is
<br />nornally arithmetic arc~agc (geo.r.etric •rt crage fur bact_rial pares:n_ters) o~ all sample mcasurcmentc fur each para~ ie!~ .•
<br />obtained during "Il!,vitvrLz; ^;•1i:1'; "ai,ri:;rr',;z" and ;;ii,:i.:..'::r" arc nor.nally ex'rtme high and luw mcasLrn~ifnLs
<br />obt2incd rltu7ng "...,;il;rtlra F'ri . '. (Nn~.c to monicii:: is t'. i'.': se: ondary Irca(m~rt nqui:fmcnr: ):n!cr 30-day St'f arc
<br />Of .`•ampie' mCaSLremePiS L'n[~.ei 'i~V_'I-~b'3," u"Ib C'PtC• rLXiml•al 7-Cl~)• EVfia~f Oi Sem71C mCaSLrfmCL:~ ob[aina' during
<br />monitoring period under ",Vi_zrimzr,n.")
<br />u. PnCr"Pe;;;zi!R~•aui,~m'u!""or eachpar,t;r.,;tcrwid_: ";:r.n~~~_~". 7 "Quolirj,"~~spec; ic:iinpcrmi..
<br />7. Under "itzu r:" eon,. nwm;,cr ofsamplc ~reswcn=,~ duri ~g m^nfru:'ng F_riod iha: r;.ccadma;:imum (:rd'ur miP~mr,u-
<br />or 7-day ar~rage as appruprr4) prrmi. r_yr!i~c. 'ur _ach pe:a, ~.er. 'croac, e :.~, "0 .
<br />S. L--^,lfr " ~;'J.~lu, , rJ,' .r:]J ,,,,,; .. Fut'a .. "~. '1 ~L .i ,\ „ 111,' r. „r" ..f ; i,~'•
<br />. '~ , _ ' t.cttal fr.:;cr.. s_^F!ir.g znd aral:,;.s rsed ct_ ,
<br />ruori'.oring pero~):_; ~! as~" "_1•:rit /f_.4~ir°,:.,:."s:c•Irr_•~ in pc -r. rt. (cg. !:ntcr ".'a,-r,"ra cantauos r cn~lurirt, "1/7'I
<br />'or uu ba.y ptr c. ac::, „1/30" fur uac ei~•' Fc moc:h, "1/,,^0" far unc dr.y per yw•uter, clc.)
<br />~. L~ _r "Si,, t L IJ%~_' both as "°' ::(L' , ,_. ,. .:Ir.,' ~ (,:ctuc~ s_,rn': ~,, - ~sfd uo~irg ronitorin~ cfriud' anr' us "F ;;u!
<br />R_.Ir•irs,n_-,. t," (c.g. .=Y i "Gr_(-" for :nwviciuai ..~mpl_, "34F~' ;c' 24-':a.r ccrr~posiL. ';!/,'" for continuous
<br />m(imlORng, CIC.)
<br />.0. 171tfr~ vioh.~~ons of )f1"rrllt ~e:p:~: _~_ten 1, arc repe, .c~, ut.r:ai c bri_: u:.plana:ics La ccncribe cause and cuacetive aCiun.
<br />to L•c tal:c~, wnd reference each violation by date.
<br />11. If"nu discharge" nceurs dung oonitur,nd p, rice, c.; c.- "ide Cisco gr" zcross far, in place af:,a;a ernry.
<br />12. cnier "Nsrzr/Ti!!r rf' /-Si/zciL~l Ea:ariir~_ G~_a-~ tvitli "S~,-,~'.~;rr: Fr::~ sir ~' Fc__-r:Irv: OjJ?c~~ of ~ut,S;,~iz~J
<br />kL;enz, ""Tel~p;z~n ~ ;Jrr,nFrr."and "Garr" at bottom of form.
<br />13. d;ail signed Report to OGice(s) by bate(s) spn_ificu in pcmrt. Kctair. cupy Cur your records.
<br />I4. Nore detailed instmctions for use of this Gis.:hs;gz i~doniror;ng R.rL-.r; (C,1sLiJ fog mry be obtained from 01fce(s)
<br />specified in pcrtnit.
<br />Legal l~totice
<br />This report is regaired by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully coo 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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