Pa~erwor~ R~~uc~".on Act Notice
<br />Public reporting burden for this collection of information is estimated to vary fro.n a range of 10 hours as an
<br />average per response for sore 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. Environrrtental 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 />l~eneral Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Fermittee Name/ivfoiling Addrzss (and facility name/location, if different)," " Fe»nit Number," and "Dis::harge
<br />Number" where indicated. (A separate form is requ'ved for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring P,rrioJ"covered by form where indicated.
<br />4. Enter each "Faram~•tzr" as specified in monitoring requirements of permit.
<br />5. En[er "SamFlr ,41 •ssur~nent"data for each pammcter under "iarantiiy"and qua/tq~"as specified in permit. "Av_rag •" is
<br />normally arithmetic average (geometric average fur bacter+zl parameters) of a'I san.plr measttrem~rts fur each parameter
<br />obtained dwiag ".LLni!•.ring r~ri~J'; "bl~rinuun" and bfininuun" arc numtally -::home high :.rd low measurements
<br />obtaincc during ".'~G,nutrinb P.: i• ±". (Kote to municipals qi,h accondary trratmenl i_quiramcrl: Fn[cr 30-dap av~:agc
<br />o`samnle mcrstuements o.rccr "!kv_.~z;_ "ard enter meeimum 7-dcy arcrcge o~"sam;~'c mersunr+:nLs obtained durin6
<br />motriloring period under '7Naximunt.")
<br />L. cn,:r"r~,,;vi[R-_;r%,_nrrr~r"`u*cachparamatcr und:r•'~.r~rtin"an_„'iu~ti~~"atisr:ciicdinpccri~-
<br />7. lin ~.i '?r •. F_ ~' ritcr r.umh~~r of sample me'±;uremrnt d~~ri~-g n,o~~if ~~ng ;-c i.i~ t~ •~ c~:c~:,d mr<~n-um (and.rur m~n~rum
<br />a' 7 d.} avr,zgo as ::, proprate) permit requirement for each pur^~~reter. i f rune, ci:fct "u".
<br />6. i:nte- "Frr; r;r~ ~ ;FRr,ahsi~"tut~~ cs ' .. d~;.• ni-rr„ _n~" (;c6~". ~".s~r.~rcy ~, sm~n;:'in~ ant analy=is ~,sed c~rirr;;
<br />T~onilon ig pcr:odt and as 'T~r,oir rte; crir: ,n ~!~"spccifcd in pcnni:. (c.g. i'Li~i "'•,,. r,"nor cun~:~.-~ua.a mnnitc~irg, '7/7"
<br />f^r aye eta; pet n~c~ c, "1/30" for one day per m.anlh, "1%9q" for one day per qurnYe~, e.'r
<br />.. Enter "S.r;,i-I_ T,~ y •" uoth es "S~,drh: ~~;":.r~::. _a::_rr!" (:;ct: al s~niple typo .~,ed du:a;; rr~onitotzns forted) ^n,; as ",r -~-,r,il
<br />A ~.7ui,-,•ut_~. r," (e.g. ii trot "~roh" for indi~icual scn-~rJ~, "?4+; ~" fir 24--ho:~:~ ca:np.»i_c, ".?;:(" for com.i•~crus
<br />monitoring, etc.)
<br />10. C:'xro •-iulrtin~s of permit re~uiremcn~ arc reporicd, attach a b~ icf c e;~1_nrtio~t Lo : =scriEe cause and ccrccl~eu act!ons
<br />to be taken, and reference each violation by date.
<br />11. if "no ~ncirtrge" occurs during monitoring period, cr.;.r "\o Cischara^" aness loan in pL: c of d:'.le cnhy.
<br />12. EnWr ",N~rnr/fide of Yriu;iF.a F..r~.xnir~ (,fji.•a-" with ".Sign_rturz of /'ri+e.ii.a rrr_+n; c: 0~:~, •f Aertlr~.~i_J
<br />~fgant, ""T~fepfnn~ ,Vwnl': r,"and "Car„" at bottom of form
<br />13. A.rlail signed Report to Office(s) by date(s) specified in permit. Rclain copy far your records.
<br />]4. Moro derailed instructions for use of this 1~is:lrarge /vf•,uhoring ILr1~~.;1 (DivfkJ fnnn may be obtained from OfTice(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by taw (33 U.S.C. 13Ig; 40 C.F.R. 125.2'7). 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 than one year, or both.
<br />EPA Form 3320-E (Rev. 03/99)
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