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~a~erwork IZe~L.~cl;ion Act Notice
<br />li Public repotting 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 1 S hours per response, including time for
<br />reviewing instructions, seazching 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, disregard instruction directed at entry of that information aUeady
<br />preprinted.
<br />2. Enter "Permittee Nume/Mailing Address (and facility name location, if different)," "Permit NumEer," and "Gisrlv~rg,a
<br />Numtzr" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "tLiarirw'ing Peri~.l"covered by farm where indicated.
<br />4. Enter each "Furam~4'r" as specified in monitoring requirements of permit.
<br />5. Gntcr "S1mF1 ~ ia_vszvzmert"data for each paramc!er under "~u~ntit} "nod ~rrllrrp"as spccified io ~cnnit 'Avar~e: " is
<br />normally arithmetic average (geometric average For bacteria] parameters) of all sample measurements for each paramucr
<br />obtained during "Al.nirorinb Fai;.1"; "nf~zirruun" and ;~ftni;runr" are normally uztrcme hiyi and low meaat!'e:ntnt,
<br />obtained du:in~ ".A~1.rrit-~r ine F~ric a". (Ts.'o[c to municipals u•iLt seeondery treatrc rat nsluiremer,i: °oter 30-day avc:~ge
<br />of sample mca;tuemenls tinder "Avaags,"and enter maaimu:n 7-day avcrzgc of sample measuremen_s obtained durutg
<br />monitoring period under "rVaximrrrr.")
<br />6. L-: '. r "1'rn,v%! IZ Inir ~nr err!" far each parameter cndrr "~:t~ rarity"and "[iuality" as specified in peT~i't.
<br />7. lirder "N: Ec" ems num~cr n°sample mcasu;cn_n: during monitorng Tcr:ed Li~.a'. e~ceci mas~•rc~m (and/or miri:aum
<br />or 7~lay average as appropriat:.) permit reyuircmcnt fur each parameter. If noon, unto "0".
<br />0. :'m.s "Fr:;n „~, /'~',v/}sie'•both as "S_.,y L• t;_~~r,r~,;r-;; '. (:ctLa! ;;tqucn,~y of s:.,npling a.d an;;lysis a:.d dur'
<br />iovniloringpcriod) and as "F_n,rit R~;uir•tr,,.r.;"s;cuificd ir. ~cnnrt. (c.d. cctcr "~.,~r,"furcontinucusmoniW.=n~, "1l7°
<br />for one day per e;ec'c, "1/~0";0: one day p.r montlt, "1; 90" foi uae day per quarter, etc.)
<br />S. Ent,:: 'Sarry_,'r T}F.„bath as 'S~,:yl,: rio _rvrertn:_,r1"(actual ram uu (yp,: used du~ino m~ritoring pcriod) and as "I', rrt%r
<br />2/.rir am?." (e.g. ;'ester "G,-..E" for :ndividucl saraplc, "1yH~" for 24-how cumpvsitc, "i:'/A" fur confinnous
<br />monitoring, etc.)
<br />10. l'Jlrcrc violctivr.s of;,crmit ratuimments arc rtported, attach a brief explanxtinn is describe cause and eormctive acs io ~s
<br />to be t<.Icen, and reference each violation by date.
<br />11. tf "na discharge" xcu s daring monitoring period, toter "No Discharge" across form in place of da~r emry.
<br />12. ;:n;cr "Na,;rr/7;rra cf Frircil'i! Erarutiv~ ~fj%_.v" with "Sibnaurr_ .j Prirr_i1 _ri Erz:ulir G~.~r of Arrl;, ~,ri_s,.l
<br />At;_nt, ""Telaplrrnz A'unrher,"a.nd "Gala" at bottom of Farm.
<br />13. ?9ai1 signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />~4. \?ore detailed instructions for use of t]tis Gis_lvrg~ eYlonil.ring 2Fart (GkIR) form may be obtained from C[}icc(s)
<br />spccified 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 than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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