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Palpei°work Reduction Act Notice
<br />Public reporting burden for this col.r:ctiom of information is estimated to vary from a range of 10 hours as m
<br />average per response for some minor ac li[ie:, to 110 hours as an average per response for some major facilities,
<br />with a weightad average for major and moor facilities of 16 hours per response, including time for reviewing
<br />imstruc[ioos, searching existing data so.:rces, gathering and maintaining Lhe datr rr~d~, and completing and
<br />reviewing the colllection of imformatioo. Seed comments rzgazdiog the burden e;[imate or any other aspect of
<br />this; collec[ioo of information, incLufir.; suggestioms for reducing this burden, to Chief, Infonnatom Policy '.
<br />Bn~nch, PM-223, U.S. Environmen4d P ~otution Agency, 401 M Street, SW YJa+tir,~,to~, DC 20460; and to the i
<br />Of ice of Information and Regidatory 4:airs Office of Rlanagement and Budge:, ,Veshington, DC 20503. i
<br />G-eneral Instructions
<br />1. if form hx; bean partially cemp~eted by preprinting, disregard instructions di uteri et zmhy of that inforraatior
<br />already preprinted.
<br />2. Enter 'Permio'ee Name%4imling~ Ae'dress (and facility name/locatio_., if ?.fftrent)," "/'ermif .1'umber," and
<br />"Diccharge Nunber" where indicated (A separate form is roquired for each disch::-ge.)
<br />3. Enter dates bct,inning and ending ' ". hunrn•inx period" covered by farm va:crc i dicaled.
<br />4. Enter each "Pc: ameter" as specified in monitoring requirements of permit.
<br />5. ENCr ".Son.ple d.leasummer,r" da4t fc~ eacn parameter under "Q;mntity" and "C ra!ihi' in units specified in penni!.
<br />':~I erage" is norm:dly arithrnetJr. e,°:' ~•~~ (geometric m~crage for bacleriz! :a~~. ,^'~;.-s! of all SinplC rneasur*_•meni:
<br />far each pr ran+4er obtairca dcria; ."~n nrrrrg P:riod", ".1/rix,munr" a,d. '.'~;!.rru+,.' are :o-m;l!} exlreare ltro`
<br />wt~i iow n!c.~siremerls oh a ned .1 i~g ".I1nn;tonng Prriud." (TQole .o ~.~ ~ c~p:lr `r,lh seco~a.~ry tmat•-rrri
<br />rer.~remrr!: Inter 30t1a~ ~• ors;;: o~ ~ u:p!e me:amremcnts w+d: ",I•.•a-.,gc e .._• ,r~: ~mwr. 7-day avcrr:~c
<br />of dcrnpie nci urcrncnls o5tlinrd r ^r r~ r~cnitoring period under ".t fcrir.. an ",
<br />6. ~ntcr "Pcrrd..:equlremenf fir e~.d h ~:: rame[er under "Qunntity` a~~~' `Qunliw" .ss s?,ccified ir. porn:
<br />7. Ura_r "h'n r•~' enter nurr,cr of :;.! o'c mc~surmcnts duri!:g To~•~I'or'r ~~~: cd hm~. e:~c.~^:' n:a~imum (anc.'a
<br />m: rmtrm or 7 .ay asrragc.~.s aaprrp ~.:_) pttmi! requirenum for cash parer ,. ,. ".!un., en'~_r "0"
<br />8. Enter "Freyve.rcv oj.lnols;e" bcth v "Sample ~;easunnenl" (zeluJ '.crp~c. n of sampling and analysis uteri
<br />du+ing monitoring pcnod) r.d a: "P. rcri Requn~euren!" specified in pcrtnil. c. g., ?ntcr "C'nnt," for continuctr_~
<br />monitoring, "/ T' for one dry per .~ ee t, "; '30" Cor one day per month, "!/JO" (o~ o~te da}' per quarter, etc.)
<br />4. Enter ".Sample Tvpe" both s ".Snr.r?,'c ,:Ira.curemenP' (actual sample t}•pc ui_ ~ d ring monitoring period) znd as
<br />'T. unit Rryu!~emrnl," (c. g., G!f~r "rr: b" for indivrdusl sample, "2~:!rl("' b- 2d-hotrr composite, "h'A" ier
<br />continuous tno~~iloring, etc.;
<br />!.0. R'1!cre viola~c rs of permit r.:quin •r~ r. [s ire reported, attach a brief e~p!:~~.. t'..•n o describe cause and con. active
<br />actions taken, ;md re(ernw rach'•~ol Gon by date.
<br />I L If "no disct.arg." occurs during mo tiu;ring period, enter ".Vo Discharge" across ionn in place of data entry.
<br />L2. Enter "Name'7itle ojPrinaoai fi]er dive Officer" oath ".S'ignature oJPrinr;r~a! crecutive O~mr ojAuthorizea
<br />Agen!," "Telephone Number," and "D~rte" at bottom of form.
<br />Il3. Mtdl signed Reipori to O~cc(s) b} clan:(s) rpecifed io pennil. Retain copy for }our records.
<br />Y4. More detailed instructions fir use cf .~ its Discharge Afaniroring Report (DdIR) f.~rr~ may be obtained from OBice(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 II.S.t'_. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in rivil penalties not to exceed S 10,000 per day of violation; or in criminal pemaaies not to exceed (25,000 per day
<br />of violation, or by imprisonment fir not rnc!e than one year, or by both.
<br />EPA Form 3320.1 (P:ev. t38-95)
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