paperwork Reduction Act Notice
<br />Public 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 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, Information Policy Btanch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office of Information 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 duected at ealry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/Moiling Address (and facility nameAocation, if different)," " Parmit Numba+;" and "Discharge
<br />NumEer' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing 'Sonitoring Period" covered by form where indicated.
<br />4. Enter each "Paromeler" as specified i^ monitoring requirements of permit.
<br />5. 'enter "S~np/ ~ Mzaruremaat"data for eac:t parameter under "Quantity" and Quality"as specified in permit. "Av; rage" is
<br />normally a ;ihmetic average (geometric average for bsc:_riat param,ce*s) nfall sa• p'c measuremaris fur each pa~~rrteter
<br />obiaincd during "Monitoring Pari^„y'; '7~f~.rin'n,.r" and Mi,vc,rmr" are ro-early e;' c;ne hi~t~ and low measurem.enL,
<br />Ob:2 mfCi dU~ng ":'~LAIILrIng Prrio /". (hiOlC t0 mLiu iC1~P'S `. /Itll EeCOnrlaP• t: CC;C.e i~: ~ .~~LLlrc r.7C nt: EntCt' 3C-day aVC1a~C
<br />of ^smpla measurements under "A L'zY_g{"ard e11Ci rla.a ^tr'1 7-:i.~ . cue O~ 5. -~; r1C me^_$:ICTnCItS Ob[alned d.u . g
<br />monitoring period under "i/..uirrur,+.")
<br />G. :~'~.~';°e%;:1~,i,•.;ui;:era:rt"for eachparame'enmd:, "Lrv„lily,". _ liN co-, :i.,ed~np~rmit.
<br />7. lrrr~c; ",~' "" u-.'.^-r.umber o~samplc mc~sueme i' du.i~o nor~U.~'r,r, .rc ' c ..__. „~::i.n~'nt (srd;r,r m ~d .~. .
<br />ur 7-.iy avc, age a, a; nropriatc) pemii requi;cmert for each p,:rmcte,~. 1"'e^a, a ~l_ . .
<br />,,. 'n[cr "F, •;u_;,_;~ cf,:+„I}'.ei.e', bath r; "5.~:;vrlr i-' . ~, ,r,+ •, _ 1 ~ ,u., , '' - -,ltli^~ ,ti en^_'ysis us:d wring
<br />a: acitc in;; :c:iod) ,od ~ "Fa:,u! Re~,rl/~•1:Sd"spcc`ficd in n; ..nit. (,.~ `ntr, ' .. " fa- cnnfincou~ monitoring, "1 /7"
<br />for o t c;~y p.:r ;tee!;, "//30" for one day pc- man~lt, "I/90" fer oce r;~y i:.:r qu:• ~ ter, c'..)
<br />9. '.tt,;,• "~ ~;arh: T•,F~"bout rs ':f~+,+;,! • i„ _-r~r,+~;a/, :"(..clear ~.nnpl° hoc ~-_a dr%- -„onitr•~ng pericQ) are as "1'_.-+ai;
<br />R~lui.r+;>,;,i," (c.g. L'n;x;,' "G,>F" for i:dividur.l camp!;;, ""H=" fc. 2~-1tc, Jr:.rmpocire, ':~'/A' for cc^.':ai~ous
<br />monitoring, etcJ
<br />', 0. t',rtcro v~ol~ticr. of ]-~crmit reeurame ~Ls a,c rt; oCcd, ~.t.:cS : 1r~ic"r:;,'- r, '' n 1- .'_.c i';c curt enu enrrec;ive aclicna
<br />to be taken, and reference each violation by date.
<br />1 1. If"no c;iscSarg;" oecss during monite;irk I;eriod, e.iter'^.'c Cad; r ~ , _rc '-.. • ~."da'a u~[ry
<br />12.'-nter "]lr]i;12,T11/d Gf Ti'In7(d/ /'.CSC711/r'e (^~~_•'i'" ~.'•~~ ".1:~.1." ~( ^1',%- .':'/il'•~if%':rr''~~i;l^ii'.~;-•/
<br />Agent,""TzlepLcna Nu+nt:r,"and "Ca[~"at bottom of form.
<br />13. n'ai(s'bme:l 2e, ort to Cfi~ce(s) by dates) specifi c;u in permit. Re:a~ ! ~•up•~ fc-; n ~ .:, i:.
<br />]n~, i~rOre GCtali eG mSfi'l!ChOI1S for L'SC of Qt.S Cis;a L~;~ I/i',. ifG,7,+g .2',~'. ~. T.~., ~~ .1 t7C)' i~7 n':D~ '`CQ irr~, ~„ _ _`.\
<br />specified in permit.
<br />0
<br />J \V ~G~L ,rLV V
<br />This report is requited by law (33 U.S.C. 1318; AO C.F.R. ]25.27). Failure to report or failure to report truthfully can result in
<br />civil penalties not to exceed $10,000 per day of violation; or io criminal penalties net 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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