|
Paperwork Re~~W~lon 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 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 "Permiftee Name/Mailing Address (and facility name/location, if different)," "Permit Numhzr," and "Cis.:harga
<br />Numtr~' where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Matitorin~ Psric,y"covered by form where indicated.
<br />4. Enter each "Param ~tzr" as specified in monitoring requirements of permit.
<br />5. Enter ".Santpls M..'~SLIY~Illdnf"data for each parnmcter under "L teantit;"and ',.iu_tiil}~" as specified 'n permit. 'Av>r.g=" is
<br />normally arithmetic average (geometric average for bacterial parameters) of all samiilc mcasurcm~n', for each parametrr
<br />obtained dw-ing '4il~triprin; /aria'; '7vL*i„urm" ant irlfni,+uoa" are normally ~;tr,.me high and low mcasu moment,
<br />ob:aincd during ",tl-,qiP ritth sari. ~". (1Vo.a to municipals wi:h secondary treatmcn' r,quircmert: Enicr 3~-clay avesgc
<br />of sample measuremenLS t'adcr ".;v~ra~~,"and toter maximum ",'-dry wcrags ofsamao musarcrrent; obtained during
<br />monitoring period under ",Yfaximui;~.")
<br />5. rY2r':~'aaitLiri.l.lil~l2n1J111"fur each paramcra~und,:r"z;•o:rit;"an:i °~'tfJli ;,"as ~neCl~Cd in p.f7n".
<br />7. Cnd.r "N. F~," entu~ numbe- of saTplc rncnnure~nc~;' during mm,it,~ring i,. ~:~~? t'•- ~....•:ccec ~r,zr.i -..urn (aodrer mFc~~-~arn
<br />e: 7-ds}' avzr~c rs .;:propria[e) permit requucmcnl for each paramcte-. If ncne, enter "C"
<br />^. CnLLr "Frarr_a:^1 ~y`.id~!}•.crs"bnY' as "S~,rrL• •'~! .~.r,:r_,., ~;n•' (,~eturl ircyue^cy c's.- n;-,;ing a d anal;sis used dciug
<br />monitoring p:r;od) cr,d as "Psr,,it R_.ici~~r;.,,!"specified in cl:nlli: (c.g. Fr'~r "..,,~r "furcontinucus moniturir~, "U7"
<br />far ant day pa c;ac!c "!/30" far one dad per month, "I/90" far one day per quart-, sic )
<br />°. :i~trr'[5.,,;r!- T~f r"bcth a: "Sl,nrk A1_•~su-stn-,N"(ach.~al sample type used during mci:itnrin; p~iod? and as "~~nntr
<br />Ra.7uitvmanl." (e.g. Enter "..^,raf" for indicidlial sa~nplc, "191!_"' for 24-hour cnmpesitc, "t`t/~" for continuous
<br />monitoring, etc.)
<br />10. C,'hcrc ~~olaticns cfpermit requirements ;rt rc~orted, attach a brief exp!auation to describe cause and corecrivc actions
<br />to be ta4en, and reference each violation by date.
<br />t I. if "no discharge" occurs du,~ng monitoring period, enter "1o Dischmre" across form in place of data entry.
<br />12- Enter "Nant/Titk rjFrin:ical F_r__urii." `f}s~.r" with "Sisn~trrr,: rjl'rir'ii1' F_r~_vr:c~ ry,,:,a oj~iu!h.:izeJ
<br />/.'kenr, ""T~lephalr Nwnf ter,"and "Datz"at bottom of forzn.
<br />13. Mail stoned Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this L-is„h1,g~• tLf~nila'ine R.rT;;7 (C6.1RJ form may be obtained from O~cc(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is requrred by law (33 U.S.C. ] 318; 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 than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
<br />
|