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Paperwork Reduction Act Notice
<br />Public reporting burden for this cc!!~_ction of information is estimated to vary from a range of 10 hours az an
<br />average per response for some minor facilities, to I IO hours as an avenge per reaponae for some meJor facilities,
<br />with. a weighted avenge for mayor and minor racilities of l8 hotuaper.re8poace, including tittle for reviewing
<br />instructions, searching existing data sources. Bath-nog and maiio4ining' the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other azpect of
<br />this collection of information, inclodmg suggestions for reducing this hm~ien, [o Chief, Information Policy
<br />Bench, PM-223, U.S. Environmental °r~h_ :i~~n Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regtdstrp Affairs, Offico of Management and Budget, Washington, DC 20503.
<br />General Instructions '
<br />1. If form has been partially complet:;d by p:ep:inting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter "Permittee Nnme9LlniLr:g .; • cgs (anu facility itamellocatinn, if diH'erenl)," "Pdrm/t iFum6er," and
<br />__. "Dsclmrge A'umher" whrrc in~iicdcd fA s:p.rale form is required for each dtscharge) -
<br />3 Lntcr dales bcgimiin5 ;c:i coding ,1!:.nitnring Period" rorercd by fo,m where indicated.
<br />4. Enteres::h"Pnrnrnvt:r" .,,pc_~~~~r:'a:nonilor~ ~ ur:.;;~cutsofperntil.
<br />5. Fatter "Sampfe.Lfensurn„rnP' da:~ for ca:':' ;.a~;r^a: r under "(h;unrih" and "Qun1iN" in units specified in permit.
<br />". t v~rns. " ig nornn!I :: it;uncic average (g:.on;ctric average for bacicrinl p:u;:meters) of all sample measurements
<br />Ibr each parameter cb~:~ m•d dungy +;:.~+nng "cried"; "a;m:+a~n:" anii "'J+nirnem" arc normally extreme high
<br />and ioK measurements oh~nm:••'. ~ nc "i!;uv,ruring Pcr:ud" (Note to municipals eith secondary treatment
<br />requirement: Enter 30~a} aunL.: ,.f s; n.~~ ~ n„;urcmeras under "Averaor." a::d enter maximum 7-0ay average
<br />of sample measureme::is obtain ~ c•~r ; t.;o;,ncuns N.nod under ".4lnrimmn 1
<br />fi. Enter "Permit Reywr~~~~ v;" "-. ,9. paran:erer ur.d.r 57unn[ity" anc "Quality" as specified in permit.
<br />7. Under ",\ro la" enlc~ .u:rnbc: -if ~.dnple measurn~s:~~+s during monitoring pencil that exceed matimum (and/or
<br />minimum or 7-day avem„c as .: ;~r0-.:•9ieJ t .amt req~lircncn; for each parameter. If none, enter "0".
<br />8. Enter "Freyuencv r;~ !r ohsn" ',.,h as "S':mrple .1ha~urarenP' (actual frequency of sampling and analysis used
<br />during monitoring peno~i) a::d ^~ T+rn,i! ::eyru+r,rtn+" specified in permit (e g., Enter "Con[," for continuous
<br />monitoring, "Ir7" for on: d^ p.: ~ .~ k "1 i (i` far cae Ja} per taenlh, "1 '90" for one day per quarter, etc.)
<br />9. Enter "Santpl? 7tpe" b^.h as ' •.l~'c " a~.rrer+:enr' (aauai sample ripe used during monitoring period) and as
<br />':'ernrir kcyutremenr" 'c ~. r`.:_r tin•4" for individual sample, i°?aH!"' for 24-hour composite, "N'A" for
<br />continuous :nonitoriu, ,etc.;
<br />I!t. 1Nttere °iolations of pcrmic re+i..:r:n•e:~l> ,:rc rep: rtc•d, atlncfr a hticf explanation to describe'c'au~e"ahd corrective
<br />- caiotts Taken, and refcrc++ce •aci: vtoi;ttion by date
<br />t 1. If "no discharge" ab1:r :;~~ _- - -'-• -~-..-._ ~_~ ,_;,,,_';a:gr" ~ross~rm in place of data entry.
<br />12. Enter "VarneTi[lo ojPrinc+"~I 'rxu;.re U.Jicvr" with ".\'ixnature ujPrinripnl rxeeutive Officer ojAuthorized
<br />.~ig?n!," "Telephone ?.an:5er~" ,rm "~:u:.•" at Follom of forte.
<br />:3. Mail signed Report to tlffice(s7 b•, s+a~e's) ;t>a'iticd in permit. Retain copy for your records.
<br />14. Mme detailed irstructions t^:.~X .•~ =is Cischa;fir nh+nrr~rinx Repnrr /DAIR) Corm may be obtained from O6ice(s)
<br />s[xcilicd in pcrrti:.
<br />Le~~t Notice
<br />Tltis report is required by !sw i33 t.'.S.C. 13:8; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />rosult in civil penalties not to er:c:;:~ $;0 ^G9 p.: day cf ~+iclalion; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by impnsomr,er,i fur :.• ~+ r,ore .iron one yeir, or by troth.
<br />EPA Form ?320-1 (Rev. 08-95Y
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