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Paperwork Re~.~.~.~'cio~ Act Notice
<br />Public repo; <ing burden for this collection o~ information is estimated to vary from a range of 10 horns as an
<br />average per response for some minor facilities, to 110 hours as an average per response for sonic major
<br />facilities, with a weighted average for major and minor facilities of 18 hours per response, including lime for
<br />'reviewing instructions, searching existing data sources, gathering and maintaining the Bats 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 "Pzrmittzz Name/M:ri/ing A~drzss (and facility nzme/location, if differenQ," " Fzrmit Nmnhzr," and "Disclrorgz
<br />Numhzr" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitorir:g P,.•ri•.:l"covered by form where indicated.
<br />4. Enter each "Fararnet~r" as specified in monitoring requirements of permit.
<br />5. Ente: "S~rvElz n;a~crn-envar!" dzta for each parameter under "~uanrily'"and '~ ri(ity" as specified in permit. "Avs•var" is
<br />normally ail~tmcdc average (geometric avcia~e for becteriz] pa,..maters) of all sample mcasuremo;ts fo: each par:u~eter
<br />obtained during ".'vL r:i+,rine ~rrio,l"; "iv7~_-6+rum" and iviird,,.~•rn" arc normally ~.aireme ;;igl and low mcasu't~ents
<br />ohta;r.L;d du i,:g ",L;•,;,i,;ri:rb Peri•, /". (Ncte tc n:"ricyml= ~,::Ir s.:condary tnanncnt ro,u r~mcc[: Enter 30-day average
<br />O~>:n"iIC ~T.CaSU~Cn'~°"~iS L~r~_Ci "n i~q'1~;1 "2nd en:Cl n.r.. ;a^~ 7=guy a~'Cia 2,,3 0f SL m,,~_ m..aSVromC-tS Ol)t£m2C GL1Rn~
<br />monitorng period under "dhuinun:r.")
<br />G. in+. "I•enr~%+.4:.; e•ir~di_'.'(" "nr each paramet_r cnJ~ _ „ ruj .r.; '; at-~li~'~ ~~ s; , ci5cd 'i p~~r-„';.
<br />7. Crd.r 'i~.'•. Er'' enter r.wrbe, of ~a~*' ;'e mc:.;urema;~ :wring n'e.r' ~ :n.: - -~.~! thy, ~_~+~c•_~d ma•.im~~rn (.~d,'::r m~n~:nom
<br />er 7 d:y a~•uagc a a;~propriz~c) permit reyuiremr~n ur each pr .:mca•r 'I cone, L.a'L:' "0„
<br />S. ~rte~ "Fr:n'rr~, •y` 1n+~'.ei~~' I••rl'~ as'., ,y r_ ,...~.~.~._„ ,~~" (::r'u~' ,"-crLn~.;,.-y is:~~~th'~-tg nrJ analysis ~~scd ~L~ng
<br />n;cn`or'~y ce~'n°) a,L~::•; "I.';-,nL ~~_.fOV.:.,l_~irnSpCCifi..l~ iu fcnn~' (a.g. I~ 'c •'..-., u."riti cent nuc.,, monib,rir,g, "; /7"
<br />P ~. ^•ie da;' p.. v;~e!;, ";/30" fog ci~a cl<y t:e~ mont~t, '•1;9q" for one day per C;cL:nw, ^~. )
<br />.. 'li+c, '[S'~c,j '_ Tj; ' LoC~. s "S_,~y/_• .., _~~}, . _,.. , ~ ' (r ,,l. . ~ ;n-.pl, L; ~ c r.~d ~:urirli mr~ ti [c*in~ paint) am as ~ _ ,,,%r
<br />r, •1e•i~;,n_rrl," (c.b. `=ntcr ";iivt " for `.ndrridu.a .,_~.t~:'_, "?d.f ' fer 24-'to~~~ cu:rP~,:ito ''.%"' fui carrtL•ucns
<br />mon;LOring, cic.) .
<br />IC. ~; her violatu,~s of penni. rcqui;cmcn:, :ue rerm'c.',, .;te," z h. is"c:p': n!!'io ~ to inerihc cause and ccmectvc actions
<br />to be lz?:cn, and rcfcrcoce cash violation by date.
<br />11. ;f"nn dischzr;;e" occurs doing monitoring p.rirn', ena'?•'o `.',~c ~;.rgc" :;cress Porn in pla_c of dz'a enl~y.
<br />12. I:nicr "i:'aurelfilL sf Fritt_rf ~l F..rlv/i~~, Gfj' _, ' vrith Sl,~rrrr~ aj i'rAr -i,% i' L• r: -~•'iv_ ~ifji ~" rj /,ut5~,ri=~.~
<br />~ x=nr, ""Tz(eFkor•.• iVwnl z.;"and "L'atz" at bottom of form.
<br />13. Mail signed Repot W O~uce(s) by d:ac(s) specified in permit. Retain cony for your records.
<br />]4. More detxilud instructions for use of this Lis_;u+de lvbnilor-inb Rsr•,r~ (/'d1R) 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 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 both.
<br />EPA Form 3320-1 (Rev. 03/99)
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