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~'a~~,~~w/irk Re~uct~~~ A.ct Notice
<br />?ublic 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 hours as an average per resporse 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, seazching existing data sources, gathering and maintaining the data needed, and
<br />completing aad reviewing the collection of information, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PM-Z23, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, BC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />~- Fneral 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 "Pzrmittzz Name/Mai(ing k~drzss (and facility nameAocation, if different)," " Pzt~li! Number," and "Dischargz
<br />NrrmFer" where indicated. (A separate form is regttired for each discharge.)
<br />3. Enter dztcs beginning and editing "ivfonir~ring Pzriof"covered by form where indicated.
<br />4. En[er each "Parantztzr" as spccificd in monitoring requirements of permit.
<br />5. enter "Slntp!z mieasursraan!"data fnr each para.ateter under "~ua,tti.ry" and (iemli!} ° as sptcifiec' in permit. ';4r~ rah,."'c
<br />rot malty a_ithme[ic aecrage (geo~rci-ic ave~mge for bacterial parameters) of all sumpL nmasureme,+ts for each para:=eter
<br />obtained du'ing ";>i•.ru;'.rino Peri,J" "ivicir.rrrn" and ali:rionm~" ar, noi.nall~ c,. trcme hi~i a^d lm.v measure;hrrl•.
<br />ou~aice: du,iu6 "'.;ori;;rinh f ri;_"' ~(I•'ote to municipals with sennuler) Inalm:.,t r.t,irement; T-n'_r 30-dsy avi_ a~ c
<br />of;a~;~p'a mea,crements undrT ",;ve.•_ez,"a• d ente nu!,cim,,,-, %-:;; r_ve~ge of s£m;tle measureracnu obtaine,; doriug
<br />monitorvng period under ";v.'ixiraw,t. ")
<br />c. ::n:cr 'Pen;ti! tZt;t~irzr~_ar" for rx-:;t parnr^r•er urccr "Quanlih~"a:.d "~,ruli.7~"as sp.:ci icd in ]t_nn~C
<br />7. U~.d^_r "i,.~ '.::" r_, !: ~ num~ar a`s implc m, ~vurrr._ ~t C~.r,'nq r,~u ; u i~q c,i~~d thy' c c~•cd ~ .; .',~ r : -,diur mi; ' nwu
<br />ur ;day a+~~tgc as appropriatcl p.:nit nyuircmei t'or each pa:a~rah•-~ if none, cnt_r "/%".
<br />S. ~n _~ "i•i~, .vt_^ `u~%..S° bota rs'„_ ~ t • ,H..n:r~.„~.,, _:! . - .,. :il^~ r:n_ ans'~;sis , sue: i~ l io
<br />rnotr;'.or.ng pu:.od) ar.a :. "1 a:mi, 2~t~n~_,,..,~,"s^o_;fi~p in ptm ,l. (e.b. yinb_- .•: r,' " ., n.»i.n-: ~, ",'/7"
<br />'f..conttnd`_s
<br />'fl•~ nre dry per p~~._'{• 'i,'~(i" ~7i o~ie dam FCf l*~illh, '•r'~O" fo: on: day pCr quiSCCr, C~c.)
<br />S. ~-::~._; 'Sar, , !u T 7 : " uurh us "v_.,.; !s " (zuual scmnle ty,
<br />_~:ur:,rt •, ~.,_d dur.. „ ~nomtn~m;; l,c~a•` ans ~ "~ •~ „rir
<br />R•.ir%r,:.;fr;.'," (:.~~. : ntcr ';irul•" fur ind;~.id:~~l ;,;:ntplc, _,;;~ ~c; 24-hcur campuaiL^^, ",1%i ' fur con~:~cci~s
<br />monitoring, c:cJ
<br />]0. GJ;terc rol.i~a:;; of^^rnit cequire,nents era rpaned, ai~adt a .,rcfespl~^atioZ iu r. ~=•ibc cau•.c std c~r.o_.i:~c a_ti,:.~;
<br />to be taken, and reference each violaion by date.
<br />t 1, if"'~ dtscllar~e° ntcurs dur,ng mor~itnnng geriud, enc:r "i:o Ciscl:aro_" across fun^ i^ phee. ofdaia cr~L j.
<br />1Z. iin;ec "1`.rartJTitrs •j i'rirt_i/a( /iu_alirz Gjjr~_." with "SiSn!nrr: cf T;:rr i{'. r:.cs_ulr~•e !~uj7_s rJ`:;v~;>.,i~r.l
<br />Atiznr, ""Ta(zrlr~,na nhuuFsr•,"and "Cote" at bottom of form.
<br />13. idai] signed Rc~crt to Office(s) by date(s) spccificd in permit. Retain copy fur your n:cords.
<br />f4. More detailed insituctions for use of this /~i.raiurbe nl~uir,r5tb 2:Purt (G;v.~ ferci stay be obtii:•ed Crem OPicc(s)
<br />specif ed in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 131 S; 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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