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Pa~ea-~vorlc ~e~u:ytion Act Notice
<br />I Public reporting burden for this collection of in°ormation is estimated to vary from a range of ] 0 hours as an
<br />average per response for some minor facilities, to 1 l0 hours as an average per response for sumo 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 in=otTrtation, 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 Off ce of In.`otmation and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />I. If form has been partially compieted by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permi(tez Namz/Mailing Ad+lrzss (and facility name/location, if ditTereot)," " Pzrmit Number," and "Discharge
<br />Numl'er" where indicated. (A sepazate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Fzric y"covered by form where indicated.
<br />4. Enter each"Parameter"as specifiediomonitoringrequirementsofpermit.
<br />5. Enter 'S~nrpL n9aaszrrenzrnJ"data for each parameter urdcr "~ulzr(i.y"and Lizrslir)•" as specified in permit Av.~r1d~ "is
<br />normally arithmetic average (geometric aeeragc for bacterial parameters) of all sample measurements fnr each pamm,acr
<br />obtained curing ".tl:nit.ring /'~ri•,,("; ".'viadramu" rnd i.fnirmm~" are normaliy cat-eme high and (ow measurements
<br />obtained du,$ig ";r(-,nir.ri,ra rrri..". (Note to rn!.r;cipals ~sith secnnd:.n,~ [reatmcn~ rc-tu:remcnt: L-nter 30-day averagt
<br />of sample mccsurcmcrts under 'Ava~se,"and cote! maxu,unn 7-day average or samnlc mcrsurcmenls obtained during
<br />monitoring period under "iviaximum.")
<br />G. ..°.rttr "f.„rrii F4 /uir~uz~at";n- each parame~cr undo; "~,;r,;; i,•r"and "~ualiry" as sl:eci~ied in petruit.
<br />7. Uai~r "; J•. ! r" enter number of s;.mplc rn:a=uranem ;ionng mm~ito ing n;.rind t'~. t c~c~od macimum (and/ur mini;uuu!
<br />or 7-cl y average as appropriate) ~c~ ~uil requirement fJ* each parameter. ?Cnuna, color "0".
<br />u. F,ni~ "Fr.•;rt~n:y of~,r~~lys'e" cofz as "S -;.,,-r. ~. ~: e,~r.•,:. -,. " (actual frequrr.cy of s.;mpling and analysis used during
<br />~onito~~ng perod) rnd as "•" ~ ~,aii R~;arir_m:r.r" specified in ~cnni'. (c.g. Ln:cr ' :our."far con inuous monitoring, "t/7"
<br />fe; nnc day per tvcck, "]/30" fnr one day per month, "1 90" fm' one cay per quarter, etc)
<br />9. tinter "Sts; ~ Tjy_"both as "S.,rr/Is 1 ;•~;r,., ~,.ml" (natal sa;nple ripe used during monitoring period) and as "I_rnr;t
<br />R~~~eirem.~r:r," (e.g. 1?mer "Gr~:zh" fur indi~•~da:.l . r, in'~~, '74f1'.. for 24ho~~^ cmnposrte, ":1•%9" fo: cony rucus
<br />monitoring, etc.)
<br />10. ~'Jhen violztiou of permit requirem~~~t, are rupoCcd, attach a brief esplrna+ion to d,~cribe cause and corrcctivc ac:iuas
<br />to be taken, and reference each violation by date.
<br />1!. i"'no disci~argc" occurs during monitoring period; cnt_r "Vo Dixharge" cress form in rlacz of data entry.
<br />] 2. L.nler ",~r~rnJTitla ~.f Fr%ncii ~l F..r_ -uric ~ :fri, a " with "Sibn.,;urz cj !-tin •!! ul Exa.utiva O~_ ~r ~f Azrllr~,ri_ul
<br />Agent, ""T •Irrhon ~ Nurcl z:,"and "Gatz" at bottom of Corm.
<br />13. Mail sibmed Report to O~cc(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Gis_(urg.: ,Lt~.nir•,rin;; R. Fort (C;Y~J form may be obtained 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 [o 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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