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~~'~g~;~~w~;ri~ Re~uctio~ 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 resporsc for some major
<br />facilities, with a weighted average for major and minor facilities of 18 hours per response, include ng time for
<br />reviewing instructions, seazching 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 fern has been partially completed by preprinting, disregazd instruction duected at entry of that information aUcady
<br />preprinted.
<br />2. Enter "Fer-mittse Name/Mailing Aldress (and facility name location, if different)," " Fermit Number," and "Duchargz
<br />Nurr,Pzr" where indicated. (A separntc form is required for each dischazge.)
<br />3. Enter dates beginning and editing "hioniroring Fsric.J"covered by form where indicated.
<br />4. Enter etch "Paramzlsr" as specified in monitoring requirements of permit.
<br />3. toter "S ~apls i:d. ~surs;;unr"data for each parameter under "~aJrrli!j'"and ~h!~/ir, "as spcci fieL +n perrniL "Ar•er.r~s" ~s
<br />normally aridtmeGe at eragc (oeometrie zceraee for bac~e,ia~ pa!an;c_ers) of all sa:,:ple measurcmems for e:,ch pa-ame!_r
<br />obls'ned du;i,r;; "iri -nir•.rino F v i,d'; ..~ sin~u,r." and iii„i,ewu" aro normal!, c>,tramc 'sigh rod ',ow mcasurorncni;
<br />oUla;ncd during ":.; wlr ri,v . °'r'-1". (Note to municipals v'i+h sccur.dar} veo[mcr; r.-.;uircmcnt: F,n ,r ?0-d::y a4r. age
<br />of s~rnplc mcestnemcnis under "~;i~srJ„.," ar:d ente.-m2•rimun 7-d::y ave.-zoe of~cmplc mcasun mcnts obtr.uied dr,rieg
<br />monitoring per.od undcr';:;.uhaum.")
<br />G. 1_--!L. "r'c,v.:i' iir,+tli::~r;~sn!" foreac;t parameter wtdcr "~~!_;uir~ "L~d "Q;r.ili7~"as s,:ecifie ;n po+-rn~
<br />7. ilnder "N, tr" enter ~um'.:a e'samplc n~.: :ur:r^a.i: d'irr.~ rnrn,iin-~ng p_rr.d :',..I :._~.d .rx::~ ~n:m (:nd'cr rnir;'num
<br />or i-dLy:~.4'EI'a(`C us appro;,ri~le) permit requirc;ncrt Cur each paramcte:. lfnonc, cn .r 'Ti".
<br />8. _ _ '.4+ ,!~, ,jF~IJJLPIS"both ~ti "S_ ,,. '' .._ r.•r_,c'.. (Latcl rr;,~LLCi ~; a"s. r!- :;;:na ana~psis .•scd dv,.~~~
<br />noc'!a;;ilg!nu=o::) ~nS rs "F_,-~,;il Re?ri,~,,;_~::" ;;e_iii~d i.: perm~f. (e.~. ':nlc• " ,. , " ilc ccr~ti t .o:.s rt ~ni[u~in;,', "/i7„
<br />fcr o~c d:.y ~:. r. cc'y "1/j0" f.7: oae day p~.- manta, "1/70" for ore day per quartur, ctr.)
<br />9. cr.,_. ":i J,. ~t L ij ''coot at "5~,: -~~ .:JJ' ..:,utr,"(ac tart camp:: hT- uc.cd dart g -?rif~nn -e.iod'' c _ _. ,; rii
<br />Rs.Jr'irsdrea!." (e.a. _ .fcr "CrJi-~" 'fo iariividr;:i s:,mp~c, "?d~~" or 2d-hcnr c'.•~nnr.:itc,~ ',~:%". .; o: cap:irmno.~
<br />monitoring, arc.)
<br />10. C,'hcr,: violzGxu of, cnnit re_,L~-tmc tts are reporie:, atECit :. i,rieCc.:plsrva'io t to . cs:ribo c~wc end curs.; we c_::o:t;
<br />to be taken, ant! reference cacti violation by date.
<br />11, if "r~ dischaz~c" xcws du'ino moniwrvr,g period, r'~ti rr "1~'o Gischaroc" across fu rrr. i,t ph~.cc of o„ia cr~t.y.
<br />12. En'..: '7dams/Titlz nJ F.-irv::i~J! E.cs_ediv: Grj!_ -r " tritil "5?yuJ~krs "f J'rh::%i -,.' r_cs.r'ii,'• t)yi:., oj' n'urJ;-.,-cz./
<br />A~'ott, ""TeJe~.': sns A'rr.nbrr, "and "Fiats" at bottom o l' Cutm.
<br />13. iYrail signed Report to Office(s) by date(s) sp:;cificd in pcnnit. Retain copy fur your rJcords.
<br />14, iJorc. detailed instruclions for use of [his Dis:Jrarbr Monitoring 2pcr7 (ti:L,7tJ form may be ob4ined Snm OFiicc(s)
<br />specified in peraait.
<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 Cailure to report wthfu'ly 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 oCviolation,
<br />or by imprisonment far not more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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