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I~~ ~Y3~~~x%~~~~°'°~ ~eda~ction pct l~~-~"-°~,~
<br />~r._ b ~..1d 1. ~u C..l ~'s
<br />Public reporting burden for this collection of information is estimated to vary ;rote a range of 10 hours as an
<br />average per response for some minor facilities, to 110 Mows as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 18 hours per response, including time cor ~
<br />reviewing instructions, seazching existing data sowces, gathering and mai~i2ining the data needed, andl
<br />completing and reviewing the collection of information, including suggestion for reducing this turden, to
<br />Chief, Information Policy Stanch, Pbi-223, U.S. Environmental Protection Agency, 401 M Street, S ~N.
<br />Washington, DC 20460; and to the Cffice of lnfot~tation and Regulatory F,ffairu, Office of Ivlaaagement and
<br />Budget, Washington, DC 20503. ~I
<br />General Instructions
<br />I. If form bas been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pernrillee Nonre//vlJi/ing Rddress (and facility name location, if different)," "Permit NumFsr," and "Gischarge
<br />NltmFzr" where indicated. (A separate form is required for each discharge)
<br />3. Suter dates beginning and editing "rtiforntJ)'lliG'Pel"7^J"covered by form where indicated.
<br />4. Enter each "Paamztsr" ns specified in monitoring requirements of permit.
<br />5. Enter "S~urpl~ .bL•~.~urdm: ru" daC, irr each paramcte- under "Lrr.nv!it~"and ~aulri~'"as specified in peen L "Av.+v{." is
<br />nor,nally arilhmcl~c a~•cragu (geometric average forbacte~izl pcr~;nte:rs) ofall s ntnle rtersuremcrts fa' each pa:nmetrr
<br />ob'alncu duri,,g ",'vh;ri•.ri+o T•riiJ"; "'.dr.~ir.a-:n.' z.id .:1mo,~um" a"r normally r,:.trcme high and Inn measurements
<br />obtair~•_c: during "d:;n:ic,i,rs P:•rr.u"'. (T~4,te to m_n cinals c.iili se~u~u:u7~ treaimcnl ~cauiremerC ~nicr 30-day ~vcr.i~e
<br />of satnlile measurcrc~~": once "i"~.~ •,-1;_ "mtd i.nlcr •,..:i ~.~~ 7-d:,; ut~:~~~~c uf._a ;~': mcasur:rt.nh obtoinau d_~~r~li
<br />monitoring period under '4L:axirvrm.")
<br />o. ^u~~.".....-,;,irR.•Sri,~sra,:.rr":oreachpzrai^_tar~nc'~_-"~~~-„ ....."~.,,.'q;r'a;>;~_ri°r_~'Ltp.r~i'.
<br />7. U. JLI "IY•1 Er" enter nu~oar. o"sc:rnrlc ncavu.c acre c' , it}; - ~~- ' - ni -. _ ;cc.:;1 ~-.a; fn,~m (r~si~- mh mr
<br />_.7-d-yaverr~_°as_;pronrittc)nc-ritr~~,.i~c~:~,nt'~.-c..dt-_.,,~r_t....'fnom:,~n~.~
<br />C. Env-'7';_, _;, •,f ~;;. ,l~:ei.'t: L' as '~~ ~ .... ~. '!. CI ~rC. e) _ --1 no n~ld :ln~l '6:5'SC,~ . "1^~
<br />~~~uritornn .cr;od) a.nd as'"r1~,~,.;~i ,2.,,,r,~_.,: ~n~,.sp°.~f:.G ~~, t:r~~. ..g. i ~";a ' .:. ",.. onr:~n:'o_s n :ni.cr;r~, .,//-„~
<br />fe Inc da; pc: weele "1/30" fu* one ri::y rer mnn~h, "lin/1•' fc nr.; lire; per yu^r'cr, ; :.;
<br />°. =refer':S~,;a''T)t.„both.s".Sl,l~fl.:6,:•.~.~c•.~er.~,;,,,(aa~'ai... ,y~,:~~~.-d~urin~m:..:?cring~n~•.ioli~,:c.,as'•°.-,n+;
<br />~•,~r~i.,,;r:,r~;' (e.l. :,r;cr "Ur~F" for ;orli~icaui ..~t. _ „~.•r;,." 'r~r 7.._ c~.n?:n,i.e, '•,'/:" fur cor~ircn'.'s
<br />monitoring, etc.)
<br />IC. ':'.". ,-~ ~iut.tion~ of permit requ~rrmcnLs ere repcr.c', a(tac'r ,- o_~~'e:i : n.tiici !u ascibe eau~e anu cotter rivr. ; ctina .
<br />to ba ta!:cn, end reference each violation by da:c.
<br />' 1. If "no discharge" occurs dvr:ng mn*titcr log p^rirx' er::. "'•~r '.'~.rL~rgr" icrus; ~"err in ;,'.ace of c sta e ~;~~~.
<br />12. Enter "Nurr:/TirL sf Ii-i:1~iF~i £r,•s.u!ir~ ;f," _ ~.vi~h ".St,,r!:rp,re r./ I; it ,7 =,nlve !g;'i ,•, %f f;l~!.'--~„i .-I
<br />~;oan!,"'T~(eFG~n~A!umter,"znd "1_'ar~"at bottom offom.
<br />13. 1'a~1 s greed Report to OLicc(s) by date(s) s;,crficd in p=rmit. Rctni^ copy ior~ourrcords.
<br />14. ivlere detailed utstruetions fo.- use of this ! •is~h~;fie rbi~.rritcriud R7 ".n (/ ;.,RJ fo~.v may to obtained from C[15ce(s)
<br />specified in permit.
<br />Legal Notice
<br />Tuis report is requited by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can resuli 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 mare than ove year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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