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 Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office ofInformation 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 insWCtion drrected at entry of that information akeady
<br />preprinted.
<br />2. Enter "Permittea Name/M~iling Address (and facility name location, if different)," " Permit Number," and "Gischarge
<br />Number" where indicated. (A separate form is requ'ved for each dischazge.)
<br />3. Enter dates beginning and editing "Mav[oring Period" covered by form where indicated.
<br />S. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Eater "S~mple +Li:.rsuremzat"data for each pz*ameter under "Quantity" and Quality" as specified in permit. 'Average" is
<br />ncrmally arithmclic average (geometric average for 6ac'eria] parameters) of all sample measurements fcr each paiamclcr
<br />obtained during ":~;•„tiloring Fericd'; 'Y.Lerisieot" and ldini,nwn" are normally exireme high and law measurements
<br />nbta~ned durnig ".';~nih, iag Periol". (Note [o mwricipl_s with secondary trcaizxlcat requirement: °_ntcr 30-day ave::,;;e
<br />of s. rnplt mi-asvremerds under "i.ver Abe,"and enter maximum 7-d1y avcrnge of sr nple measurements obtained dy':.g
<br />monitoring period under "i/,,aximum. ")
<br />6. Enter "P6r/.17~ R[i~nr~,'e~n2~7'" rOi ei C~~ I`~rllnlCffr ^nril'~ "~iiVn7ih/" r':d "Qi!ah/y° as spcciticd in pcrmii.
<br />7. Urdcr "A'-, +: _" . ~i:- number cCsa:rn!': m~:~sereme~lt d'i~inp, moni~arfnU per.'od tn:d c.aceed maximum (anc~':.r mini~~., •.r
<br />or 7 gay av: ml;e s rp;.rop,ia[c) pcr~ -'; n~.iLi remert for each parameter. If none, cote "9".
<br />8. ~ni~r "F~'_:l~r~,•_)~ :f, ~.•l, ~.,~x" h:~th as "S rr, ,n/~ i'c.,e'~ro,r1,~7" (actual fr:,c,u: nc;' of sr.~pling red analysis oseL. d~_~; ins
<br />monitn iro period) ;..:d cs "Fer,.~'+ 27;•i,-r, r;,r^ t,nc~ifiad in permit. (c.g. Enter "~'llll,"for continuous morriiorin;;, "//7"
<br />for on;; d:.y per c; ee':, "7/~0" ror ore d.y ne- month, "7/90" for one day per quarter, etc.)
<br />9. :%nta; "S_`a;fle T,Fr" JBih a5 "fug : ~/r l;:a `,:;n a.!" (actual sample type used du-ing monitoring period) err av "..„nit
<br />R:yui,rm_„!," (e.g. Ent_: ";,,vr-" for Lldividunl sa.r~plc, "?4HU" fm 24-how composite, ""r/A" far can'`ncoas
<br />monitoring, etc.)
<br />1Q. ~~i]f rL V~O1F iIJ,Io 0~ : ..°.1Trilt -J~L'~ NSCP S: C: L' rLy Orifi_, aCiidr a brief explanation iD dCSerlJe Ca CS.^, and enrrec,we 1.^.::0,75
<br />to be ta',ceu, and refe~nce each violation by date.
<br />11. 'f"no discha-;,~" occ_ s dur~g'^_~ `:.~ ing pc iod, en'cr "No I:'sel•arge" across form in place of data entry.
<br />12.nte,- "N~cr,aTi;le ~;`,°.irr_,~al ,~ .~~+riva G7Jr_.:r" vv'Ih ".51~977L[1'e of Prir.,i/_,I F. reutive C~x;~ cj~tur,'r,-_~z
<br />Agent, ""TelepTroaa Nur+Fe,•, "end "Late" at bottom of Corm.
<br />13, sail signed Re,:c,t to C"~'.c(s) .; -'_t•.;.; specified i,r r;;-mit. Retain copy foryom rccord,5.
<br />lk. ?More detai'.ed insL-aciicns ".- ' s. o°" ,. l;is:l~ ~,~•: i,•; .;iits+Lrg Rsr•,r4 (Cti1~ form may 6e oStaincd fre- C' i=:(,;
<br />specified in permit.
<br />.~~~P ~~~~~~~
<br />This repori is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to repoR or failure to report truthfully can [csu.'t ir.
<br />civi; penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violalion,
<br />or by imprisonment for not more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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