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~'~~ ~r~~-work Reclus~tion Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 ho•.trs 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 infotmation, including suggestion for reducing this burden, to
<br />Chief, Information Policy Btanch, PM-223, U.S. Environmental Protection Agency, 40] 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, disregazd instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pzrntittzz Norm/Mailing Address (and facility name location, if different);' " Fzrmit Numbzr," and "Dischorgz
<br />NuntFzr" where indicated. (A separate form is required for each dischazge.}
<br />3. Enter dates beginning and editing "Ivl~initorinb> P~•rioJ"covered by form where indicated.
<br />4. Enter cacti "Forametzr" as specified in monitoring requiremcots of permit.
<br />5. Enter "S1tnplz rLkasurznr~nt" datz for each parameter under "!,:uantlh,~" and ~rralih•" ai specified io permit. 'Ar.rrub: " is
<br />normally ariflrmetic average (geometric average for 1; .cteral parameters) oPall sample measurements for each parameter
<br />obtaiocd duri lg ".L;•,:ur,rin5 P_roJ",r,".;v:: o-Lnunr" and lolirrin;um" arc normally e'aremc high and low measurements
<br />obtaincc. during ".:l.ait riot; 1'.•ri~!". 11lOiC to mnn~cipals o; ;'h secandarv treatment rer,ui,cm~^C '-ntcr 30-day avc ~g~
<br />of 57 m~i'.P mE~till`ement5 L.rder "% L'1,'1,~I," a::d enter T.t'L' ~".um 7-day a~crage of Ram~~'e ml:£Sllrc'mClr l4 Obtained duRll l~
<br />monitoring period under "M,rxinun;r.")
<br />h. '.:4c~ "/'s.;+:i!R~1.,r•.:msrrt"fr.-ezchyarame._rmrci~-"~,r,,a:h'„and"!iu./i!d'uspeci icdinpel.i':.
<br />7. Under "i~': F.x" eater nambot of samp'c n~:a.unment dtn inE n:urii~,ring pc; ind t' , : ~~cccd muiir.um (andior mi limarr
<br />cr 7-dry :IVdrt,^,e r5 tppranii;ue) n_mit rcquircme.~l fur each narnnc[cr. !f nnao, rntel "0"
<br />u. i=nter "Fr ~u. y •,jAn~ly~ric" hod, ~s "° s.,r: Y7. .n, ..., ' (aRurl ~,-enuc nc „nnpLng and analysis used curio;;
<br />monitnri.lg ner:vdl end as "/'_;-rr~! R.-;uir: n, •r.t".nECifi~d in r:~mu! (,.g. ~ Iaer "_ .,~,,' ion coot:nce~s monitor,'rg, "//°•'
<br />for one day par c. ce'.., "//30" for oac Gay per rr.onth, '?,9q" for one day per quarto*, e c.}
<br />9, !?nL•r ",Santrl • T ~ ," boll as ',S.t;lrpl.• ~ f.• -su,~a.; -;;!" (acWsl san.rk t}T~_ u.~d uurin~ monitoring pcriou) and as "!'.•nr.t~
<br />R::".fuirr,nerrt," (e.g. ?:nte- "Ca,h" for indi•.'iiieal sampl_, "]4i/ ; for '4-'~c:'~ composite, "A7!" for cantinucut:
<br />monitoring, etc.)
<br />10. C,'harc cinla[ions of permit requirencnts ar n:i;o'ed, attach a brief Expl~naliur to describe cause and enrrect:ve aciuns
<br />.o be taken, and reference each violation by date.
<br />1 1. If "no discharge" occurs during mnnitorin~ period, enter "No Discharge" acros, form in placr of data entry.
<br />12. Enter '9VnnrJTi1/z :j Trinci; ,~! Fx~,tttirs Gjfi~.t'" with "Si,natr•r.: of f'rD;;if,l t'r~:util•: O~ ~zr nj AurhorizeJ
<br />/,'bznl, ""Tzlzphona Nunr!-rr,"and "Datz"at bottom of form.
<br />13. Mail signed Report to Oflicc(s) by date(s) speci(cd in permit. Retain copy for your records.
<br />14. 'viore detailed instructions for use of this Gis~har~~• ,Lf.uilorinb Rep~d'r (CA4fiJ Corm may be oh~ined from 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 truthfully can result in
<br />civil penalties 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 tLan one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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