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~'~~ ~.-~~'vork Re~~,.ir~~on pct Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 het>ss as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major
<br />facilities, vviti 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.V~J.
<br />Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />~e~geral Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction duetted at entry of that information already
<br />preprinted.
<br />2. Enter "Fermittea Nome/Moiling Address (and facility name/location, if difFerenQ," " Pzrntit A'trmber," and "Discltargd
<br />Numbe,~' where indicated. (A separate form is required for each discharge)
<br />3. Enter dares beginning and editing "Monitoring Feriod" covered by form where indicated.
<br />4. Cater each "Per,zmsur" as specified m monitoring requirements of permit
<br />5. F,nter "Sar;rple rYL~asar~na,v" data for each parumeter under "tuanti0+"nod'%u 21ih~" as specified in pe,~cit. 'Avm ae•e" is
<br />~aonnally arithmetic avc,~ge (geometric average for uuc~erial parvmeters) of all san~plc mea",uremcnts fnr each parameter
<br />obtaincu doting 'Sl,'nrir•.riuo f'~l'".!"; ",19~::Lawn" and i~iinin+urr" arc normclly ccnrnx hibl a_td loci mcaswc-cats
<br />obta•ae `_ during ";.i~.aito, ia8 T •ri•.!". (Vote to mnrici; als with sccond;_ry treatment r.:eiu~rement: Later 30-nay cverabe
<br />of sr. t-,!c +nensurerncnis under "~:rav;;z,"nod enter ;-cxi~n,m• 7-day avc~gc c. same lc m:;isurcm_n's abl: iueG d'_rirS
<br />monitoring period under "i/,,~xirnm~,.")
<br />G. F.nVr"F.•,ori'.&~uire,a.:n!" or each pa*amcttr!uu.~ ,~ru~in•"and"zru/ity"as specified np_nni:.
<br />7. Jndcr `Ib, Fc" enter rumucs of sa~~•tple mca::uremtnl ri+~ri•~g n ~u-::'o~ ing pc,~od 1`c' +:.ua;l mrr.i~nom (, rd~cr ,;i a~r•um
<br />cr 7~ dc~~ avert as tppro, riatc) : omit rcyuircmcnt fln cur.. par.~m~,:~. if none, enter "0".
<br />8. E+t:~=- ", _{~r,_u_;, ,.f.tru/;'s'~"both rs "S_~,.~r !- .t _~+,;,,•... •+r:" facturl °;,,et~e.•cy o" : ~nf~;~e~ ;;n_ aril; t,~s .sed i r irk
<br />mocitor ty pored) and as "T ;+,;it 2-/erirz„rar!"srecili~d in fe-ra!' (e.~. Pita ".-,nt,"iiir ~ant'nueun nroniie~i.:t;, "; /7"
<br />far anu da•• p[r wc::k, "i/30" fnr one day per n-en1~, "//r0" fa; rn~~: day per qu:n7u, etc.)
<br />S. l1nL:r "~~rry L T'T_'l;eth rs "S_nJL•;.a_,s;e_-, _, ." (.,cb~at seirple ty~c .acd duria~+monitu,-in~ (:etiod' arr as "! -~„~1-
<br />RIB!!%;'.417di'I," (c.~ haler "~; al'" for individu.,l c;,mp_, "24/i~' fur Zw-hc r cmnposite. '?'/.:" iar com'ruous
<br />monitoring, etc.)
<br />'0. CJ~~.erc ••iulatinns cfncmvt n;quirements are reporcd, atiurh a bric`cxnlcn.;rion to dcsnibe eau>c and corective.•.'ioas
<br />to be taken, and reference each violation by date.
<br />.. ~'"no d sc;targa" occo~s dv~ng monitoring period; enter "h!o Discharge" scross form ut place ofuata cnir,~.
<br />12. Cms "Vmne/Title of ir6rcil',! F,r,.:u!ir~ GJjr -." with "Si~nilte'e .,f Prin.i,r.,!! £.cs.rrivc !~~z+' rf Av;S•.;i=~t
<br />fg~nt, "'Ta1~ph.n. Nwnler,"and "Caf1" at bottom of form.
<br />13. Mail , igncd Report to OfGcc(s) by date(s) s~ecificd in pcrtnit. Retain copy for your recorvs.
<br />14. Mara detailed iosGuctiuns for use of this Lis_lra,be :Lknitoring RsT.rt (CrLIRJ form may be obtained from Ot" ic_(~)
<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 iu
<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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