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~a~ wrw~r~~ a y~ ~;`.~n ~.ct Notlc~
<br />Public r;porting burden for this collection of information is estimated to vary from a range of 10 ho::rs as 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 pcr response, including time for
<br />reviewing instuctions, searching existing data sources, gathering and maintaining the data needed, znd
<br />completing and reviewing the collection of information, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />V/ashington, BC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, 'Nashington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of [hat information already
<br />Preprinted.
<br />2. Enter "Permittee Name/Mailing Aldnss (and facility name location, if different)," " P~nnil Nun+hsr," and "Discharge
<br />Num;-er" where indicated. (A separate form is required for each discharge.)
<br />3. Euter dates beginning and editing "M,nit-.ring Park„!"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />S. °_nter "Sl,nplz i,i_osw-~~,7an1"data for each pzrametcr under "~vlnti~}'"and ~u.r!iry" zs specified in Hermit. "Ater *„^" is
<br />omlally arithmetic ..vEragc (gcorretric accrrge fo• bactericl paramctes) of zil sa.r,~ c r,easuremenis For each pa~meCr
<br />ob:ai led dluicg ".~;•,.:ivr%rrg ,°_ri: a". ",19_~rir,uo;l" cn~ thin%m.~~m" a'.: norn-~:.lly e.:;~.; t~ High and iol: m:asurernc^L:
<br />obtai lea durii~ "do',;1loring Peri;.~". (l~etc to man'd~'. 1s with scco~dr.T treatmcrt r:cu:reme't: Enter 3C-day avc-~g.:
<br />Of SaTniC mEabL'''CTnCnLti LI1CCi "f Val'ao ',° CCd CAL" ^!aXlnum 7-ri.')' uYCmgC Of Sc^rf ~iC mCaSL rfr~l;,n!S Uht, IrlCa CUII ~'~;
<br />monitoring period under "ivlarirur„I.")
<br />6. ':nt _* "^arnit R>al'i: ~,n .It".'or each paramnei imdcr "` ' ~,,tiry"end "~ua1~N" as s ecificd 'n pe-~~?.
<br />7. J:ldcl ",4;, 1.,::" enrcr numbc- of Sall;le m~a+^ru^Ciii L'Ji?:~ i~'.0 l'~J7 n~ ,;`.:"~nr .i L .cCed m1'~'TLm (C n(IiOr Ifllnlr W 7
<br />Or 7-day a Cr2 ~C rs 2;,,irnprlarL') nCrml[ rC~j :1'LTICnl 'iUT :aCh r:: 1:Im CYCr. i f']U ~~C, a11Cr "~"
<br />C. -at~~ "Frei-.,,r;' of,inJysis"baPn ac "°~ ; I_ ',!~_..-,r„ire!" (:rlurl ,°„ou-c c; r,'~an.,;i~lg :~.rl a~r!.si~. used duri.:;;
<br />n10n1 raring pcr:ad) and as °f'J..,r~! R..'J i'I: C,.''~!!" SpUCliiCri .n jdr,n :. (L.gi i_^.IC' ,'nil." ~Cr CO~~t"?aDLti ~r OiLLO,u ~~ "!~r
<br />far one day per ~.'.c:c, "!/30" for c. ~ day per moatil, "/~ 90"for o. ~c day per quar:cr, etc
<br />4. =n'zr "SartFL T~;t _"I-oth as "S~„7.r~ ,.,~..:r, - ., r,r,"(a au~.l samrfL tync nerd _'u-~ ~;; ~anitorin,; n~.;n;) ar l as "r •n~:;r
<br />,[.!~~4 ~Yrlk'rl(," (e.g. '-:rater "~l'a(~" r0_ indi vlli L,.91 S'~ll?71C, ".~Qrr ~" fr. 24-'1 pL'. C0:17pO51Te, "~`I//1" °nr COP C+n COII:.
<br />monitoring, etc.)
<br />10. S'^:_*c viola[ion~ Gf permit requirmrnli ar reported, attach a brie` czplanation to d,:.,cribe taus:: and ccractivE actiens
<br />to he ta!cen, and reference each violation by date.
<br />1 t. ]C"oc 3ischarge" occurs during mo,itoriog pcrind, enrcr "No Riccharoc" across fo-m in plcce o'. data entry.
<br />12. Cn.e- '7J.am~lTitla cj /'rinciFa! Es: zrtr.~ ff~_er'' witil "5'i„LI_rkn-r cf /'rin:i;-_~.' FztLU(IV.: O~~zl of tildhorize./
<br />tiKeru, ""Telaphonr Number, "and "D,ns" at bottom of form.
<br />13. Mail sited Report to Office(s) by date(s) spcci tied in permit. Retain copy for your records.
<br />14. Moro detailed instructions for use of this Gis:;u,b.r !LL-niroring RAE ,rr (G1~fRJ farm may be obtainczl fm~.r Office(s)
<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 truthfu'ly can result in
<br />civil pens ties 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 both..
<br />EPA Form 3320-1 (Rev. 03!99)
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