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Paperwork IZeda~ctian Act Notice <br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hoazs as an <br />average per response for sonic 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, includi tg 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 form has been partially completed by preprinting, disregard instruction d'rreeted at entry of that information already <br />preprinted. <br />2. Enter "Pznrrittee Name/Mailing Addrzss (and facility name,9ocation, if different)," " Pzrmit Number," and "Dis.:harg,: <br />Numhzr" where indicated. (A separate form is required for each discharge.) <br />3. F,nter dates beginning and editing "lvlonit?rino Pzrir_ f"covered by form where indicated. <br />4. Enter each "Parom~t,.°r" as specified in monitoring requirements of permit. <br />5. Enter "Sarapl2 d/aasuretnanr"data for each parameter under "Qrtontiry"and [%ualih'"as specified io perTrit. "Ar~,•~g~" is <br />normzlly arithmetic average (geomet*ic average for bacterial parameters) of all s.;rnnle measutemc~ts for each parameter <br />obtained dung ",Lk;;;r•,rino I'~•ri~.d"; "6•,`:nirumr" and niitrim;u,r" aT normally c;iramc iiigl- and low rneasu~emui rs <br />abtcined during "tv~r„ut.:irrg P, r: ,J". (T:ote to munici~ ;is c :h secund:.rv treatmnt ~~ •u r.ment: ~.nt~r 30-day ave-rpc <br />o.` sa-plc t-reasuremcnts une'rr ':~ivnv~!,"and enrr.- nzx',aum 7-day at~erage n'sam;'a moos, ~cm=nts oblr nc r'ari::b <br />monitoring period under "Aiuxi,;r:trr.") <br />~. .. ',-r ",'.n;,i!R :;r~%rg,;rl:rt"roreacii paramacr node "~+~lr!iYr"nod "Qu.r(ity"as s-acifed in pern~t. <br />7. Under "T': F_r" cn[cr nwiba~ of ~amplc mcasrrerac,t ricri-„ nr.~r ~'o-~a~ ~~, noc' U•.c' _~.cc_s ~r,:::.~mrm- (: rd'r,r nt'n'r;wn <br />c %~day aver. ~~ ec :;m,opn~te) permit mq~.dnmr~t fir rach ,r..rrsmeter. If none, enter "!; ". <br />B. ;-,d, "Frr,,,_.. ~ -.f JrJ~~cic" Ia[h :u ' 5=.,,~ 1_• l., • •t~~, :,. ~,rr" (anu.!1 ^c: i~cncy o' ~a or' ng e,,:d analysis sea c .•i. , <br />moni wing ~c~~od) a;d as"/'.;-,,rit 2.~vir. ra ,u" specified in r.crmi; (: ,b, !=r.tc+ ":' .r. " fo: e~ d nun: s moni:o,in~, ".'/7" <br />fur one d: y ne- ~•: ea!c, "1/40" For r.re clay r„ , monf~, "1/90" for ono day per nt+ar[cr. e's.) y <br />4. Cnitr "S_•r,ti's T,^- "bof- ~~ "5~,,;+ le ',._...,r:_,.:. '" (^rt.::1 s.,T.t,l-: type used u.ri~ , rnn,i[r ricy nc~nd) an< as ",~rr-n:. <br />.2•,lui;~ra~-n!•° (e.g. ?n[cr "i=,.~ah" for indi'.id~ual sanp!:, '-di,'~" for 24-ho~!r co^'pcsiic, 'Rr/A" far contnuot~s <br />monitoring, a*.c.) <br />10. 1i"~_re violations or perm `[ renuirement: arc repo ,c.',, a:?ach a b*ic~ cxpianation W dacribc cause and ccnea;v~ actions <br />to be ta!cen, a,td refemnce each violation by date. <br />t 1. if "no discharge" nww-s during monitoring period, eats "No Dischar~." across fn-m in plact o.`da~a ent~•. <br />!2. F.ntcr "ft'artz/]'itlz rf Iriacira( F:.,:ulirs G,"'_-,'' with "Si;;rr~R++-~ j fi-%+':i; a' I~Cd-id;r: :~_•_•r y'' lur;r,ri:_J <br />Agart, ""T •lzplrat_ NrmrPzr,"and "C~~riz" at bottom of form. <br />13. Mail signed RepcR to Office(s) by date(s) specified in permit. Retain copy for your recurcLs. <br />14. Mere deiailed instructions for use of this fis',tarse 19wriMr;ng 2;~-.;~ (! Pr7/i) fomt may be obiained from Office{s) <br />specified in permit. <br />Legal Notice <br />This report is required by law (33 U.S.C. 1318; 40 C.P.R 125.27). Failure to report or failure to report tvthfully can result in <br />civil penalties no[ [o exceed 310,000 per day of violation; or in criminal penalties not to exceed 525,000 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 />