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~`'~~:~~rvvork Re~~~cc~ion Act Notice
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<br />Public reporting burden for this collection of infot»tation is estimated to vary from a range of 10 hours as an
<br />~ average per response for some minor faci]ities, to 110 boors 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 dzta sotuces, 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, iI.S. Environmental Protection Agency, 401 M S'seet, 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 already
<br />preprinted.
<br />2. Enter "Pznnittee Nume/Mailing Address (and facility namcAocation, if different)," " Pzrnril Number," and "Gis.-harg~
<br />NumEar" where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monitorirtr; P~rirl"covered by form where indicated
<br />4. Enter each "Parameter" as spccifie~ in monitoring requirements of permit.
<br />5. Enter "Saarpl~ r1,;aae!venrant"data for each parameter under "~umlily"and ~iua!%ry"as specif cd io pc-nit. "Are •r.rs°" is
<br />ne*mally a~9thmeuc average (gcomctr-~~ averge for h:clerial parameters} atoll ;antple measurnnea~ts fm each pammctc
<br />obtained during 'Stl~,; it .r%n, f rri',1"; "il~ciun;m" rnd Alininrrnx" an: nornc,ll~~ ezircme hir,•h and Imv measurements
<br />obtained du-i.tg "d..,r:I-n ia~, f'_ri .!". (Ne4: to ~,rat,`cinuls with secondary t2aut,cnt rquiremcatt: Enter 30-day act <go
<br />Of Sa,7ip'.e C~eaSni'eT~C1LS UnCer "/i'la'J~_',"End Cn:U .71.:C!i;~llia 7-da}' average of svn;;'c n!easurcmcat; cbtamed dunng
<br />monitar:tg period under "iv7,azirmm.")
<br />C~ ^_z cr ', asril R: jr~i,zor ;rr" :or csch par:rmct~r undo- ";icy,:rrv" ant ";'.u~iih'" 2s s-.zcifi.:d in f.crmi[.
<br />7. Ut der "i~.'; F..r" enter number of s:.T~le mra;nrcmc .:.'.:.ring mura:wing p:riod " :. e:~c°ed mc•:imum (aad~~,r minir'~un•
<br />nr ; -dcy .'n•c~-~,: r.s r repro uric::•) I•~ -mit n-qu~:o'nerd far etch paiametcr. If none., enter "0"
<br />L'. Prtc-''F,'.;odr. ~' -.f.~,:_2!)'s%r" hots es ,'^.:,r'• '/,r:•vr .,,:,~r" (acW~.! frccucrc r rs..~mp ink and an:iysis u:~I c_+iu~
<br />;~tunitrr tg rer:ud) rrd as "F_,-„ri~ f :~uir•r_•rr.~",Iircif,td in I:r:-r,,i~. (e. g. Lr~ler ".'•.n/.'~ fi,r ceati,,uots tnonitnrcd. •'//~"
<br />fcr one dad pc• r•: e;;, "//3t7" fur ene day ]ur mont't, "!!90" far oite d;+y rcr quarter, etc.)
<br />4. °r.,er "S~n;r'~ T,'~p~"both a., "S.rm/(_ .l~ ~.r,r;; :,,:.•, r!" (m gal sample t)pc used dung moritorng pcrou) and as "!-.•nni!
<br />fs uir.•r;;.:,r?," (e.g. refer "~rii"' fn: indit'idr.al sort; lc, "3411:" for 2d-haul cnmpasilc, 'YJ/A" for continuous
<br />monitoring, a*.c.)
<br />10. 1.^t.:re riolatiuns ofpcrmit requirencns are rcpc'cd, attach a bnaFexplanation to describe cause and correcrvc ac:+ons
<br />to ire taken, and reference each violetion by daft.
<br />t !. I' "no discharge" ocetus during monitoring pcrocL enter "~'o Disuharge" across form in plaea of data entry.
<br />l7_. Enter "Name/Title of ; rin_i;-.! Frs_zrriti:° Ofr.~r" with "Si,SrraArre cj Fr'i,n'!c~/ h.re=uliv; G~~a' rf Audnri= '
<br />Ay~•nr, ""TzlcF.ltstr ~ Nm:rhzr. "and "Cats" u[ bottom of form.
<br />13. Ylail sin ed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use oP this Lis_h.n~e hLnita'inb Rep;rr (G,LJR) term 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 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 bath.
<br />EPA Form 3320-1 (Rev. 03/99)
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