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~'a~perwork Reduction 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 "Pzrmittae Name/,Llailing Address (and facility name location, if different)," "Permit .NumEer," and "~ischar~e
<br />NumFrr" where indicated. (A separate form is required for each discharge)
<br />3. Enter dates beginning and editing "Monitoring Puir.,1"covered by forth where indicated.
<br />4. Enter each "Paramtldr" as specified in monitoring requirements of permit.
<br />5. F.n[c* "S,urrpl~ A9_savr~=nrrnt"dr.G! for each parameter under "~'rrlutit),"and' ralih,~"as specified in permit. 'Ar~rag~"is
<br />~~onnrlly aritlvnclic average (geometric average for bacterial parameters) of all s'amplc meuuremcnts for each pantmclcr
<br />obtained durirg ",t/,r+it:ri,ro F~~ric/'; ",bi.tcinuun" and lrfinimum" aru nutmally eslrrme higl and iuw measurements
<br />vbt~.inec; during '7~;s;ri•,ri;rb /''sr7•.~". (Nate to ntunicipnls v.ith seconder}' heaGnrnl r~ywtement: Enter 30-dry a~s~•aoc
<br />of sa:nnle mcsmemcr~; under "f;vs,•~;;.,"and enter ,nazimun- 7-day average e. s~m~ la mca.urcments obtained dulirg
<br />monitoring period under "tvilximnm.")
<br />6. ~o~ir"fn;trir;~r;.~%r~ntz.~t"C;.eachparnmcterunde~"~.rro;rih~"and"~u.r!i!r"as specified inpe-nit.
<br />7. I:.~d~r ": ', F~" enici numbor of samnle mc.rsurunrn' drrino mor~in-ing ,rriu: :: at c•.csd ma>;ira~nr (andror iuiuimum
<br />r ~ 7-~ } avcra~c e, approprirte) permit reyuircmcnt fat each parameter. If ncrc, cntu "l)"
<br />~~. ; n'e: "Ft. ; ~,,,,.~, ,~ .4,.~;s'~ " l:ntir : s "~,r,a; ' ~ 1,; v'.:~r.',,,,,;~" (achy: I frccursq• , •:;n-a~li rg and analysis use ~ du~nP,
<br />moni.ori~g pcr~n:i) end as "I'_,~„ri1 At.;u;r_,run!" specified n pcnnit. (cg. Enfei ':~~nr,' 'ior conLn lots mnnilaing, "1i7"
<br />fc: one ur ~ p: - v; ce!c, "//J0" for one day per month, "1/90" for one da}' per yuortr. , r,~.)
<br />`). Paler °:i~-d~ !1 T% ~"bni~l L ".5J/.;r! • ,1'• i~ih^_b7.'n(" (acr-gel sample typ; o~cd curing monitoring *+,;t~nd) ar_ as "~ ~„~,n.!
<br />A_yru,~uu:~r" (c.g. Ente: "Grsl~" for individual sample, "'41f,:" for 2»-hoer cnmpusiL. ~".1%" fcr con~.a~iuus
<br />monitoring, etc.)
<br />1C. !Y':~r.rt viula[itms of pcnnit rcquirrnenis arc rciwrtcd, a!tach a biicf csptana!iou to d~acribc ca!s_ and ccrmcfivc sc'.iuns-
<br />to be tal;cn, and reference each violaUOU by date.
<br />1 ], if"no discharo~" occur durirg monitoring period; cnt~•r "No Discharge" across form in place ufdata entry.
<br />In r•~n er 'Sv'_un%/Tit!d of frincir~l F..r'7Ar11L C,~ rr" raith "Sibm~ha~~ cJ Frin~iF -? F.x.~:-rtiva :~~er rf AzAhc+~ceJ
<br />/.'hart,""Teldph;n~,Vum/er,"and 'Dms"at bottom of form.
<br />13. ;Sail signed RcporL to Ore(s) by date(s) specified in pcnnit. Retain copy for your records.
<br />14. More detailed instructions for use of this /;is~lurg~ ,Nr;nit~rin~ R~F~.rt (G;~IR) form may be obtained from Ofitcu(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 than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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