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~a~erworl~ deduction ~Sct 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, seazching existing data sources, gathering and maintaining the data needed, and <br />completing and reviewing the collection of information, including suggestion for redu~irg this burden, to <br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 N, 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 />Genes ~1 Instructions <br />1. If farm has been partially completed by preprinting, disregard instruction directed a[ entry of that information already <br />preprinted. <br />2. Enter "Fermittee Name/Mailit:g Address (and facility name location, if different);' " Parmit Alumber," and "Discharge <br />NunrFzr" where indicated. (A separate form is required for each discharge.) <br />3. Enter dales beginning and editing 'iLfrnritoring Ptric/" covered by form where indicated. <br />4. Eoter each "Peramahar" as specified in monitoring requirements of permit <br />5. F,ntcr "S.n«ple h_aseu•rma«r" data for each parameter under "~nl-nutty" snd ~ualit;~" a. specified in pent i~. 'Avzragt" is <br />,;orntr'ly a*iGimetic average (geometric avera,*c for bacterial parameters) of a1J sarnpl, mcasurelncnis rnr each ptvnne[cr <br />oblaineci during ".Lf:nit•,ring 1'rriol'; "mlxil««el" ar.~ i.ii,ri.n«;«" are ^n~mally c ;trcme tug;:std lot,' m•_asure:rects <br />obt,^mc~ dm'in~ ",.`,r,L„inb 1'~,i•,!". (Tiotc to I>,ur~cirals v:i,h sccnndary treatment roam"ement t:ntcr 30-day acem;;~' <br />of sr, rplu mrasuremen(s tm[•er "Avrr~„-_,"and cute- n2 ; rn lm 7-da;~ everage o~" szmal~ meas~rerncn[s cbi: ir,c: uuiin~: <br />monitoring period under ';'~lzrinrum.") <br />G. °nscr "P.•,v;~i~R'i:~i:-a:;r~:v;" f0• Ca Ch pd~ametCi un'llr '".J i1r111~.",:rd "~illJli!~I"a5 tin CCi tlCd i^ i1.rT1't. <br />7. CJ ~:i]i "; '', ,_°r' enter r.l~mlrcr of sample me~~uremrn' dii ring mon~L: i~g ;tsi ~nd : -. t ~•:cecs ma~.~.irn r.m ([rc>''~ir :n',~ .-urr <br />or 7-0.y avers; rs .ppro;rnatc) pcnnit rcr~,`remcnt for each par,.mcrer. If n~tne, cuter "G". <br />8. r.:;.: ^/r_°;r_ ~ '.f.:,ra/Jsis"'~ct~t rs "S_,.:, r' ~~" ~~r: ~:,1 •nl" (;:ciu.l frcyucnc;~ u's: npl'tl a,.; n~21, sis -sed d~-~'~ <br />aonlto~i,g peter'') and as "/'; r,.lit 2:p'i: _ol - d" snctlGtd in ,rtnn;'. (e.g. "..:cr '~4,1~," for c ml ';c,a n~onir~:;~~g, "i r/" <br />ice nnc rlsy pc wec:c, '7/3D" far nnc day nee mo':tli, 'I/9,7"for nnc day per quarto-, ei .) <br />S. c'nl7r "~'~,;,;-I ~ Tr:. 1-ot~, ems "Ss,u le ;v; tu::.- •,: ~.u" (. ctu21 .^ rr;: tyl.: es.'d dw;r;; mo r,te.riry ncric~) e.rc us " _ .:: <br />k.•iri,r„:.,'!," (e.~. hater "Gr-,1-" for iedicidaal sc~n;71:, '74i1: fur 2~-hov- cn:r,po-rile. ':'%1" :a- co.~~~~'uc~.is <br />monitoring, etc.) <br />10. '',"'~~re •;ioht~ois of permit requizentrtL : ~ rC~crtcJ, uriac'7 a crierexplrnatio^ to d_scrue cau.;c and ccnc~:=vc a.:b.'~ <br />to be taken, and rcfercnce each violation by date. <br />11. I"'no discltzrge" occu~s de~'ing monitoring period, cut, "No Tischarge" across fo-m is place of data cu;~}•. <br />17.. En.e- 'SdartP/Pit1e of °ria:iF:'1 F.c:.vuire G~ -. ' with '$'ien~!«r. cf Feb,, it d f:.tr,rrrive Guar •~' l:;r„ ,.- <br />Aga: t, ""Tula ph one 1"wnl zr. "and "L'at_ " at bottom of form. <br />l3. idail signed Report to OCiice(s) by date(s) spcci6ed+~ permit. Retain copy for yotu records. <br />14. ivfen• detailed instructions fo:• use of this I'is,Ga:~_ A1'.«iinri«e F.~•.:-r (L;LIR) form may be obtaiacd firn:, Cf`~_e;•; <br />specified in permit. <br />I.,egal Notice <br />7"his report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfu'ly can r25[i~ is <br />civil penalties not fo 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) <br />