<br />~' PaT~~:,~{~~rk ~y~.a~c~;~'~u Act Notice
<br />~\ rting burden for this collection of information is estimated to vary from a range of 1 C itollTS as an
<br />i er response for some minor facilities, to 110 hours as an average per response for some ma}or
<br />factltn: , with a weighted average for major and minor facilities of 18 hours per response, irclu~ ing time for
<br />reviewing instructions, searching existing data sources, gathering and maintaining the data deeded, and
<br />completing and reviewing the collection of information, including suggestion for reducing this bt'sden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, ~::-O1 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 />]. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pzrnuttee Namz/Moiling Add'r•2ss (and facility name/location, if different)," " Perm%t Number," and "Dtsrhorga
<br />Nwnb:;r" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dales beginning and editing "ivlorriloring P2ric!" covered by form where indicated.
<br />4. Enter tech "Poran...°rer" as specified in monitoring requirements of permit.
<br />5. Ente- "S~rr~lz d;lasrrr_r,r.;rt"dots for each parameter under "(;¢rJnlrrrn"and ~ualin~"as specified ;n parr i_ ';tr~~r~ge"is
<br />lornzl;y arithmetic averagt (geometric average fnr bacterisi parameters) o''"a11 sanlnlc mcasircm.rLS for each p.~mmuicr
<br />oblaincd dung '4Li%~~i!arin„ Tzri~a", ".L1r:i~,rum" and dtininnun" a't norrna!ly caln~me Ili;;` and ~ol/ mtasur,, r':-ts
<br />Ob12lnCd dLLing '?.,'~.;rir,,~6re P~°riol". (':otc to m~~nicpal+ ~; ith secondary L'ea_n:cnl i.:vuirmott: ';ntcr 30-duy : vc~a~
<br />Of 5a"nO1C IPC-.SL ren-.."t_i DnGer "N 1Cl'lb 1,"and CntU' n-.." i"-1iL:1 7-dP;' i VL''Zlge Oi~ :al~'i.1C n~-SSL-L'm.n LS nul: ~~li: G:-~~~
<br />manitoringperiod under "id...rimam.")
<br />u. Eo'rr "f'..,; irkat~iraiae,ll" .or each parzmeter end:, "~r..~'%h~"nnd "~u_ilir}'" as specified In ~ :rn i.
<br />7. Und~i "i.%, Cu" enter numbrr ufsarnple m;,asu~:.~en: du~~g iron::n~~ina jcr~o[ :~' ' r..c.:ud nc::imu r (c r2.c-;.t'-~'i ~~i~n-.
<br />or 7-dzy eve ~gc as r; nropriatc) ~r~rmit rcgLrr:mznl iur each naramcter. !f Wore, c; tt "J".
<br />F.. 'inlc. "Fr ~ar,',r - y`i,vl;e'1"both as °S~. -r, ,~,~.~~,r,.,, '.r' (,:cn~z frcnurncy .1' ~., rf.':n~ ^r_ : r.I sis .:ccd ~vi,3
<br />~tonitorng period) & ~~ LLs" .,„i%: ,i:;~ur-.m.'.;r"sccclf,cd in ccnn~: (c.g. Cr;u ' .•,a!," for rr~ Mucus rroniWrirg, "1/"
<br />for one Gay pr, w.:.:!c, "//30" far one day ; e~ nonrl; ";: 90" for one clay ptr qu°,~~: ~, c.=.)
<br />,~
<br />S. -nta'S1rr /, T ' on:'t &s "S_" l_ L,_- .~~; -,,, ,; ~ci~al s.m ;~ type is.d d:nir, mu:~~tcrin~ ccre:i' zrr as _ -.,. ,
<br />kt.~r~irs~;rra[," (u.g. Gntcr "G,~~/~" for indniGual s.~npl., "Jeir~" for 24 'u,: ~ coirpcsi is '"a%i" `e~ car~ruo~:,
<br />monitoring, etcJ
<br />]0. ti!iterc violation; of permit requir.;mc~,?s aro re;.oricd, u'rtach a L-ricf expl.-_na:iun _~.' dot^bu cru.e .u1G canoe.::-,: a_:icns
<br />to be taken, and reference each violation by date.
<br />] t. If "no dtscharyc" occurs drring monitoring period; cr.sr "R'o Discharge" across form i~l prat- a`-:era nil-;•.
<br />12. F,nler "lt'!rr_/Title rif l=ria~i/~l F.~~_~u!i~'s G~:_'," with "Sl.,H1iL3'~ Of f'r%rr-i; _~r F..tis~i'%v_ r.I/i:.,. .~' ~?i,r;~'.-%-•'
<br />flgc nr, ""TaleFhon.; Number, "and "Clrs" at bottom of form.
<br />13. `9eil signed Repoli to Office(s) by date(s) specified in permit. Retain copy for your recortis.
<br />14. More detailed instructions for use of this Discln~bs M,nita-irrg RsEor! (C,r7/O form may be olllinrl f-c-~ 0~.:,•(.•)
<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 truthfu'.ly can nsui' in
<br />civil penalties not to exceed $10,000 per day of violation; rlr io 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. 03199)
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