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~'a~erwork l~Q~a~ction Act Notid~:
<br />Puhlic reporting hurden for this collection of infonration is estimated to vat-)' from a range of 10 hours zs an
<br />average per response for some minor facilities, to 110 hours as an average pcr 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 border, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.~IJ.
<br />t~Iashington, BC 20460; and to the Office of Information and Regulatory Affzirs, Office of Management a-id
<br />Budget, Washington, BC 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 "Pernrilte~ Nome%L1oi/ing AiJrzss (and facility name location, if difTerent)," "Perini! Numher," and "Discharge
<br />Number" where indicated. (A separate form is required for each discharge)
<br />3. Enter daLS beginning and editing "M;rrir~rinb F~ricJ"covered by form where indicated.
<br />4. Enter each "Pm-amrt~r" as specified in monitoring requirements of permit
<br />5. Enter "S~mpte A/,a~surs,rr_;tr" data fr•.r each parameter under "~rurdit, "and u~tih" as specified in xm]it. "Ar ~r.rs -" is
<br />aormally aPthmetic r•: crage (~eomet;ic avem ~c fist l-acterial parameters) of all s.n plc meacurcmcn's for each pa-amet, r
<br />obtained dtuit o '. ,•,nil;rir~~ -rf. /" ",12rciruum" tad Llini•r:rr;,r" ar: norm~lh : ;;rcmc hivh and low mcasurcment:.
<br />obtained dw-iig "Sf-.r~rl•.rin„ f~tr.,"'. ;TTOU Lo rnuricipuls r:~Y!~ acionr~~ tre::r]rcrl r:rvir.mc';: ; •tt.:r JGday averlic
<br />of sr~n'c mcssc cmonU a*pcr "A'"i:;~_ "~.-d ent; n-•:~; :ur 7-day acct gc c"sa r,p',: n~crsirc ,znl^ ubt~^.~ncd curi~:~
<br />monitoring period under "ivllximwa. ")
<br />5. l;n'cr'Tr;;:ilR,/air~,.r~;d" orcachpc~.rcclcrund_~'_•.rr'r.";;n,l•'~r;.!ih~"2~.,n~ci~:dini.e~ir`
<br />7. Und:~ "A' :.',?' c tt~r nu~nbcr of s: -. ,'c m'a:urcmc J ..tiny r o~ -~ ,~,; ^_-.02 : . ,c=cd ~ta~ i,ntm (<nd4 r rnin~ Yur,
<br />o- 7 dcy aver 6:: ~. ,~preonale) pcnni`, reauvc~neat Ear each ;]: ra;reter. '.•f no„a, cis; :r "C".
<br />n. .-:r1-r "f'I-L~ ~,r:;~ , r,'~r~l;si"" holy ~. '~" ,~/', ivL .~ _,,.. ' (;:crux, ,. ;,r..:c ~ ,..~n,''ir~ ., ri :~~;~'.sis a:.od c:u~i~
<br />rnon'nrY~g .-er.od) r~ _~ cs "/'_ ,. i1 R •.,oir _u n+" spc=iced in - ,,i.''. ;:.~. Lnlc. , ~ .... ~u crr,:~t; °.a ~ ortihtris;;, "//7"
<br />fcr one day ~c r ce'a, "!/30" for one clay pcr mortis, "I/9U" for or.c da; ; Fr nuartr, ...r ;
<br />°. '=n~e~ ".S. ,-'s TvDs' boY] as ".S~rnrt_ iii-~~nra.: ~a,•' (cch~a{ s.:rf,!c t;n~ u.,.d ,..~rin~ mon'~to.in~ pcin.i; ~n;1 v " _.,,,n
<br />R.aair,-,n..;1," (e.g. '_=nicr "~~.~~k" for indi-iidual .:. n I_, _<:".' `ar 2•-_~.: com:osiic, ~:Y/L" for co~.';nuau~
<br />monitoring, etc.)
<br />10. r„~!l2re V70lanons of pCT1't TCC~atTCnCliS !TC -Cf,Or'u(', ftiaC}t a h1Cff':;11."A."•hn'1 LO (iCSC;bJ C8L'::C an3 cortiJilVC aL`.ons
<br />to be taken, snd reference each violation by date.
<br />I L 'f "no discharge" occurs durirg monitoring period, ectcr'T'o Di~rh;;r~r," across fom in p!rca of flora er.tp.
<br />1?. Enter "N_"ta~/%i!la f I:inaif.r! Px~~r!/irs G~-_•_•r" wish "Si; +;~/er ~ of I ~;n_i! ,1 ('caa~/irc G~~ ^r cf Aelho;;z~i
<br />rigeru, ""Telephon: Numha ; "and "L ~t: " at bottom o f form.
<br />l3. Ptrail signed Report to Office(s) by date(s) specified i n permit. Retain copy far your refcrds.
<br />I4. iticrc detailed instructions for use of this Disch~,sa lv;.nitoring 2'F"•t! (C ~f/~ form may be obli inu from O`licc(:;)
<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 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 3320-1 (Rev. 03/99)
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