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i~'.N~~~~rwork Re~:~~~ion Act Notice
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<br />Public repcrting 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 pcr response for Borne major
<br />facilities, v;ith a weighted average for major and minor facilities of 18 hours per response, including'ime for
<br />reviewing instructions, searching existing data scurces, 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. Envvonmental 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 already
<br />preprinted.
<br />2. Enter "'err,7it[_°e Nanre/Mailing Address (and facility name location, if different)," "Permit Number," and "Dischurge
<br />Numhzr" where indicated. (A sepzra[e form is required for each discharge.)
<br />3. Enter dates beginning and editing "ivonitori77g Fer/ol"covered by form where indicated.
<br />4. Enter ei ch "Puralneler" as specified in monitoring requirements of permit.
<br />5. L•oter "Sm:7pL LL~s;n~~7aa7r"tiara for euci7 parameter under "~:run!iry" and iaroli0" as spcdfied in ;rerrnit. "Av.rlo~" is
<br />normally arithmetic aceragc (gr_o:r.etric avrrage for baclarizl parameters) ei all sample measwernents for eaca pa:z peter
<br />obtained dw-ing "LL,niP,rin„ r~ri~,d"; ,:•:r:6nvm" and 6•fiai,ururr" arc norn7ally c:;ucmc aihh sod ~o~~ mcasuremcais
<br />oLtaine during "'•% rrir.,-i„.; F-risk". (Note 41 mwtic~pals vi:h second^ry trealmc~r requircme~t f:nter 3G<Iry a.erade
<br />o:`sample rnca~urements uncle: "~iverrot,"ard c ttrr nta;:imum 7-day average of samplc measur.n:,nts obtained Burin;;
<br />monitoring period under ";vluxilr:u;;r.")
<br />6. L-u..: "/'e;,,u- /7:;rir'7rrent" or each paramc!cr under "Qrrw7Ul;~'rrnd "[nfa!Iq,"as sil:C1?iLd :n per~ll~_
<br />7. Ueder "iJu E_c" cote- ni~nber of samplc mec:~LL.me~~: dcr,n~ m,~niCn=ag p.nod th~~: ~srecd may i:nvm (and/cr m'v~tmuro
<br />ar 7-day avciage as ap; rorsia~.e) permit ryuircmect for each para7nctc:. If Wane, enter "7".
<br />8. v'_r "l'ragl• ~ruy rf:;.~Jrs';" bo;~~ as "S_~„r,-L• .Sr ~_e~:u~rra,-:" (c;!ual G,:qucccy of se~np:i~ig c.^.d anal~.sis ~~sed uorii:g
<br />nonitoriag period) 4•d ae. "Fn'.. '! /Z:!er,Sn e;r"spLC~Ged in pe:~nit. (e.g. °ntzr "~ori~,"fcrconhmmus n onibring, "//7"
<br />;nr :.uc ~sy per c,ez':, "/L30" ;'or one d:.y per month, "L/90" for one day per quarter, cs.)
<br />S. _°m _: "t ~,.~f!e -')Fa" bosh as "SJ„~T!~ ~n1ar~^eor ~:,r" (,ICtiu_1 ; empi.. typ= t s.3 during r^onit~r:n~ period) ant: as' Fa-rnit
<br />R_.!r•%rsrrznl," (e.;;. L-.r:er "G,-~/-" for i,rdividu:a samplc, '79H~" fo- 24-Loin c;ampcsite; 'S~'/i" for conliauuus
<br />monitoring, c:c.)
<br />I0. C:~ten ~•iolctioss of,ccrmit regti:emenLS me rzponeci, aC~~ci7 a brcf explanation Co cesc:ibe ca;uc and ecrrec:ive actlcns
<br />to be ta::en, and reference tacit violatian by date.
<br />I I. if "no discharge" oceurs during monitoring period, eua=c "1\'c Discharge" across form in place ofda[a eoLry.
<br />12. En:a,- "Mu:rrJTir!s ejl,inciJ,t Era.irtive !:~_~/" wiili "Sihn,!rre rf Frilt_iT~! Er__ir.'iv~ Gffr~2r q''luth„izsr/
<br />fifs'J77!, ""TeldF`IJ :nd IJumFer,"and "Cute" at bottom of form.
<br />13. Pail signed Repo,-t to Office(s) by c'ate(s) specified in pcrtuit. Retain copy for your ruords.
<br />I C. Yore detailed instructions for use of this Gu.;lrargs Monitoring Rport (G;m7j! form may 6e obtained iom Offce(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 $ ] 0,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment for not moro than one yeaz, or both.
<br />EPA Form 3320.1 (Rev. 03/99)
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