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Paperwork Deduction Act Notice
<br />nublic reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 haws as an average per response for same major
<br />facilities, with a weighted avcrzge for major and minor facilities of 18 hours per response, including time For
<br />reviewing instructions, searching existinS data sottrces, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of imotmation, including suggestion for reducing this burden, to
<br />Chief, L:Formation Policy Branch, PY-223, U.S. Environmental Protection Agency, 401 M Street, S.\~/.
<br />\4tashington, );C 20460; and to the Office of Ini°ormation and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />general Instructions
<br />1. If form has been partially completed b;~ preprinting, disregazd instruction directed at entry of that information aUeady
<br />preprinted.
<br />2. Entet "Pennittee Name%Llailing Address (and facility name location, if differenQ," " Frn»it NutnPer," and "Dischorgz
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Ivlonita•ing Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. %nt_r "S~mple i~ltastn•e,s.~l"date for each parameter tm~cr "1u~rtilr"and tLitt.lli,~" as specired in perry, t "Ar,~r,r~. "is
<br />~or,nally anrhmcl~c ave,zge ;gco~etric avcl~gc Cur lr. i!~ial parsrteiss) of ail sumpia measurements fur each para~te~cr
<br />obtainul dui o ".: F,r!ir•,rins Fir%~,./'; "r1iJJigl!'..r" a~~J 1•li:ur~ru~," arc nonnal!j c>.hcmc high ant loc. mcasurertcnb.
<br />ohtainc;; dwio;, ",., ,,:ii•.,inc; °~ric_t". (hrotc to men'cii`e's t~•~''t scamdan treatment re~,ui-cmcnt: Lntr,- 3C-day tvc~3gc
<br />e`sa^rp'e measeretr.ants under ",av~,~b.,"and cater ma:cimu-a 7-~.y ave.-c~. oCs~np~e messu'em.nls obtainer d!ring
<br />manitorug period under "ivlaxin, tr.:r.")
<br />6. ~., ~r "Pe.-,cri! R~;uir.raaul"tar eat i par;.,nc.cr cat'=: "<<t,_nr;r ~"~ --- "~r,a/i!},•' cs sn_cifie:; in peg ~ni .
<br />7. Ucc:cr "i~ro F_s" eat - numL•w o: srsnp;e ,S~~SUre.-,_.: ~ .i~~~g I: t,cit:tr' ~;; _•=,ud f,z .;;c~eL maxi-,,,n (l ~c'•k;r curl, -purr.
<br />or 7-day •rvcnge as approrrit,.te) pc•~ i'ro-;uin:mv.i fur c~ch parzr.e[e~. iC~On~, cnu:r 'ii".
<br />8. L-nr_r "Fr~.,t~-;t_~~ ~Jvi,:at~s%. ' h„lt _, ' S-. ,-/_ ..,_!s.-, _,.._,.~" (cr!_cl f urc~n ; of sa ;rc':ing an'•..naiysis .used doni~~
<br />~~ ori:oring I;c~iod) ara as' .caii 2 ~~i.~•,,~:,,. -_~~.lyd i:: iro~~r:. (c.;,~.':~ifrr "~ ,,;t," ~o'cont.:,;o.~s r•~unitti.-irg, "//7':
<br />fur an•: dr.y re • ^~e.'c, „1/30";o: one day pc- rnon'ilt, "!/20" fo: en~_ gay per quzn_c, etc.)
<br />:~. i_nIC! "J li.y :r' -_"bp1i1 £.°. ".S ~;ui-/. r. ~SCS~'• '.7 _•... ° (aCtl4"1 Sa n'r,!~ t3',l_ C: 2:J !'_~i'i ~:S ^l a-+iicrin~ pC'loo; ail u5 "nJ.)rl i;
<br />11'.]r,ir_lre,d." (.:.g. L-..,.r ":;ni" for 'ndividlJ e,~aplc, "~~li~ 2- 2~-'-:orr~,.~:nnoslc, ,~,%r" far wnii~,uaun
<br />monitoring, etc.)
<br />1 ~. \~Ih CLC ViOlsiios of perrtril rC7L:rtmCntti a'C rCrOr~Ct!, C!'..Cil C Uncf C:.lilan::;'`G~l IO r.C>.."!i:C C£U SC and L'.1'.CC;:VC aC:i Oi1S
<br />to be taken, and referonce each violation by da4:.
<br />11. If'nu discharge" occurs do Ong monitorinC pcr.ud, c.t.cr "i•:o C~sc',a-t;." across forr.. is i,l£cc of data unary.
<br />12. Lntc: '7J~.n./Titt:' of : rinoiF.! F..c__vtiv ~ ~~_, " wiLli Siaesrr, t .f Fr4t_ iF ,l esa~rrJivt G~jresr of !u!lr., izaJ
<br />iignt, ""Tdl~ph•.,.: t\'tunla•,"and 'Oafs" at bonom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in pcnni[. Retain copy fur your rcca ds.
<br />'.~, i•dore detail;d instructions for use o; this Gischsr~~ ivlvnito~i,ta F~F,r! (C1v~ fora may be obtaiueci from Otce(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is regtired by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to repor^, truthfully can insult 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 bout.
<br />EPA Form 3320-1 (Rev. 03/99)
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