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~:' ~~.:~ ~~ rl~ deduction Act Notice
<br />Public reporting burden for this collection of information is esrimated to vary from a rartge of 10 boos as an
<br />average per response for some minor facilities, to 110 hours as an average pcr resporse for some major
<br />facilities, witu a weighted average for major and minor facilities of 18 hours per response, including aim;, 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 />Chief, Information Policy 3ranch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />l%/aslvngton, DC 20460; and to the Office of 7nSormation and Regulatoq~ 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 [hat information already
<br />preprinted.
<br />2. Enter "Per~»ittae Nome/lr%ui/ind A,/drass (and facility mame/locatioq if different)," " Parmit NumFer," and "Disclvrge
<br />Numh~r" where indicated. (A separate fora is required for each discharge.)
<br />3. 5mter dates beginning and editing ",Lfonirori,lg F~ricJ" covered by form where indicated.
<br />4. Enter each "Pa, ~rrtr~r" as specified in monitoring requiremenu of permit.
<br />5. Sntcr "S~.aFI~ ,:-%s~surem~;i1"data for ends para.nc'er under "iu,~ntir~,"a,rd (ru~lih "us specified in permit. "Av.•r,,~_"is
<br />:crmall, arithmet!c average (geumehe e~ ~r.:ge for bactcrirl p;;rmcle,t) of all suniplc r,rea,urenxnts fn- each pa ,under
<br />obla~ncd during '.~is:r%l;rid;; T~r~,,,?"; ' l%ssi,.nr,rt" r.nd /Llinirmun" arc normally ~atreme high urd low mcasu~~ ~icrt;
<br />obtain cd during "rL;•.n;r:riab I' ~r; ._"'. (T~'e4 to r,.ue~npals .vi;h tieu,miarv trcatnxnl requirement: F.ntcr 30-day avc,~;;e
<br />of s~, ~~rtc mcnsu cr, cr.~ ~nicr ".'~~•,_:~;.," end cuter n-.;:'r~u~r 7-day acerigc e",. r,:!„ measurem:.nls cb4~incd during
<br />mcnit-king period under ",9%1SLi13Uil.")
<br />u. .?n ",'",.^itR~,:d,..,,,arr";c-e,chparapeterund_ "`r~rr.'and"~voliry"asspecifi~di^r];Tnit
<br />i. ~ ra., "i?•. F," en;c ru nh=, rf ti t - ;.!a r.:, .-n~c nn/ ~'uring me-;in ink ~~~=^% . : ~ ...teed ma•.ii nom sand/or rni:, mar
<br />„ iJ.yavcr~.rsnj,pro,,;ie~-~,-_-,~~,c;r~oncnt;o~cachpar.mctc-.!fner:,cn:~:"t7" '
<br />~. ~.;,""f,_;,,,;~~ .~',;.~;r'"cc;`rs ..-.,-'°..~ ..•,a,,,n"(;cup:!"rc:u,rcy~."se-~l~ng:aland,si~seedu'n~
<br />~aor '.ur'-.g ~:cr;ti) anL as "," ~,-,.li; .2:;riie,.r gin," s,c~r'~cd :n ;;u~~ri. (e.g. [: t~ "_ ,rr,' ~~;;r con: :vu: s m»i,c,~r "1 ~7'
<br />a~u ~.•y ;;-: ~:~ce': "!/30" for eta day ;.er mc,fi, "1 ib'tl" .o: o^e ria;• p^r quc•,c, ^l, J
<br />.. Ln+. - " i •,,rt-r~ Tj; ," ho: ~ :, "S_er/L• ,:. _,. . _,. ~,;,•• (. _i~•al s:..-,plc 1•~ is v~cd curn~ non'torin~ pelicdl cm_ r., "T.n,r:
<br />kr~ri~t,r,,: ~," (c.L. i'-~tcr "vra! "' for irdividu:,l s_n; !_, "~4%: "'' i.r 2t-'~~.uur rn~-!nnsitc. '.`/!" fo~ ~cP ci~nrc,
<br />moni[orng, eL.)
<br />i ~. C!'.~_;c viol: t n,~s of enn`~ :e~~,v-e,ncn', a , ene.-:~?, atadr a 1-.-icf e.~~lz ~~.c'.a~ t t~ dz~cPFe cam c end coecct ve ;.- 'ru
<br />to bz tc::cn, znd reference each vio:ation by dn[c
<br />~'. If"nu d~scharoc" nccu„ dry-off; m:,nitirin~ Pero?. cn;.r "Vn Di~.cl~srge" across funs in pLce ofda4 en[7.
<br />12. 'c.mcr ",?'~,.lr/Tir4 cj /'r%u:iF'r E-~-r,li,~ G~ ;• ~.vith "Sisn~uu~ of h}-ir,.-ir:,~ ETeculive Cy"7__~- y' hld;,..:i..'J
<br />f;ba,v, ""Trl~plr>,r_ T.~rm,l r;,"and ':^ ire" a[ botwm of form.
<br />t 3. Mail signed Rene. i to O. Gcc(s) by date(s) specified in permit. Retain copy for your records.
<br />?~, Uore detailed instructions for use of tF.is ~isvh.~,ge U~,/ri!s,-i;rg R_F%rt (L,i~ forn may be obtainec Gc/n O-fcc(.;
<br />specified in permit.
<br />~,egal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.P.R. 125.27). Failure to report or fai]ure 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 year, or both.
<br />EPA Form 3320-t (Rev. 03/99)
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