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I~'~ -~~.;~~~~ rig deduction Act Notice
<br />.~
<br />~ Public reporting burden for this collection of information is estimated to vary from a range of 10 hot_rs 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 18 hours per response, including time 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, InfotTnation Policy Branch, P~/-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office of Infornation 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 "Pannittee Nang/M1i/ing Aldress (and facility nameJlocation, if different)," " Pzrmit NvmF.er," and "Dis~ltarg~
<br />Numl'zr"where indicated. (A separate form is required for each dischazge.)
<br />3. Eater dates beginning and editing ",Ll;nitoring Pzri-,1" coverud by form where indicated.
<br />4. Fntcr etch "Paratnet'r" as specified in monitoring requirements of permit.
<br />5. I?nter "S~rrF12 ,'/ve,u z„,-nt"da 4t `os each pummc:rr onde-'~(,n~nlil7~"and ~/u~lih•" as specified in pcm~~iL 'Arr. a,{-" is
<br />~:orrially a,itivnctie : ; cage (gcorr~7ic avercge °: r hact.;ri;a pamnwters) of all sample measurernents foi each parameter
<br />oL-tair~d dt ~;.~ ",:i•.,^., ;,, ~ :,;,_t" ",1 LaL,tuar" '.,d d1i,:i:na,.r" ure nnrnmlly cAremc high and !uw measremenlo-
<br />obt~incri duiag ",i'~.r,ii".iue I_•ti .l". (T~ote'r. nun'.cir^Is •a''It secc~.dary traat,nrni r~iiuircmc ri: 'inic- 30-day zvcra~r
<br />of sa ~-:le mcau,'cments under '%v;; .•-_, :: d cc:cr ::. ;iint r, 7-c'~; ave~~gc n~ . n , ,: mtasur ~ rd~ ohlcura,' c_~r:
<br />rooni~aring period under "wiaxirtw,r.";
<br />,,. °nL. ";~~°nrit R',.~• ,,:„te.u" --`or each Para^c~:. tm'--_ °~ :. ,.~:~ "_h fry" as ~:- ird ;r, p'-n ;.
<br />7. „'~:~ ., . ._.' cnt_r rumbe- ^fs'~~' •'? rrcascc~~+c -''~ r r ~ ,- '.rir,: ,,-~.n' .- .~-_? n.. ~-: ur: (t~:dir,r rn n~,-un'
<br />. r 7-ria~ avcrt,g_ as ; ,prop~;;.tc) nc <ni: rc ~, *cni ~;'cr o~c1i ; t.r-,.c;.. -. ' f no: , , cnt.~r "C'.
<br />". ,.~ "!•~r.~ .,; ~. ,Li,~ ,!~•s;• ' iv,th : ~ _ .,. _. „ _, ' (: ~i:-1 ., '.rcr ~ nf'in~ u:' a,-.:~,~.ie use;i c;i^
<br />-^on%,nri•„acriod)an,;ns"p.-,..%~,7„r,,.:,,J" nc.ffulir-c:rh :~~ ,:,,.: .,. '~orcon,~ -_~a~roniui,ic,~„'//7"
<br />f: - .-:ne day ^_- r: e.:', "1/30` ic. c.re ~c, , , r irr "l,'9U" icr ar„ .. `y per quznc', c(c.•.
<br />4. 'tS~,--'• T••- "bcPn rs ".%c;trl, !.'_ ,,., ,. ' (:.,;t;;zt ~: c.~ b t; :- i d ,;,i,. g rt cTito-:r, icnad) a.n~ rs "/~...,:d!
<br />!. _•:t,,irri,r •at," (e.,. '~nta- .,, _,J' icr ~rd~vii',r^I .~: ,,tL- ':?,'f~ fi,r ?;-~c _„~,;ri;~tc '~:'/L" far coniir., tc'nn
<br />monitoring, etc.)
<br />l0. F,^tr c ~riolations cf n_rn*t nnuir~men^. „-.. -c :; ~c ', ar:a~h c b-ic" c;:•:': i~a±in~; t•. ~~. .='.ir, cau;c aid cc,,r~Evc ,~c`cn;
<br />to ~e taken, rod reference each via etion by dztc.
<br />'. ~. rr"no dacLc~ Vie" occu:a durirg manimr•c•R ptrna ent, r "Nn ?;i~r':::r([,•" zeress f:,-~ i:t pta,;. of ura ec r}'
<br />12, iin cr "N:mJ!'itL of !'ria.%; 1/ h:.':_tr1,r_ Gt _ , 'wish ".Sl~?i~(P,',' rf PrL 1: _+' ~,~_uriv_ O~Tx,~ of !.u!5'rn'zdJ
<br />~ig~nr, ""Telep(tr~r Nmul-er,"and "f_/~": t bottom of form.
<br />1?, A•tc;l signed Report to Office(s) by date(s) specified in permit. Retsin copy for your reca•ds.
<br />1~. More detailed instructions for use of this f is, 51td.r ;vioaii,.ri;rg R_~;a (T,'~ ;con may L-c ociained :mm C,nccs)
<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 tc 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 3320-1 (Rev. 03/99)
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