|
qy. ~ ~'a~erwork ~e~~~~~~on Act Notice
<br />t o~ g burden for this collection of information is estimated to vary from ~ range of 10 hours as an
<br />response for some minor facilities, to 110 hours as an average per response for some major
<br />ith a weighted average for major and minor facilities of 18 hours per response, including time for
<br />revle~ f1g 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 />]. 1f form has been partially completed by preprinting, disregard instruction directed at entry of that inforznation aUeady
<br />preprinted.
<br />2. Enter "Pern7itree Narne/illailing Address (and facility name location, if different)," " Fzrntit NumFer," and "Gischarge
<br />NumL-er" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitorinb P~ncJ"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "S~nrpla b; ~~saremr;7t" data for each parameter under "[.u~mi;'"and r%7r 7iit,~" as specified in pe,nrit. 'Arses ~"is
<br />onitally alithmctic average (gcontetic av;rage `or hacterial palameten) of all sample me~curemats fo; each par~metcr
<br />obtained during ".4/,lri7.rin„ !'e,-%: /'; "1./,;ir,7u~u" and rblinr,rn.r" a c nomtal'.y c:h _ •nc '-iglt and '.m:' muasure ^e,-r~`:
<br />Ohi~inCli dun7g "i. ~'. N'(:i'f.7~ r; ri. i". (IdniC in mllP ll.lpals \'A:it SCCCI1 t1:1Ty treatm C,':" '~J fCTC :[: ~.NC~ i0 ~tl:l)^,\C ~~:.
<br />Of SL~iplc mean: rer, ,-.Ls I!-.CCT °A "e,' ~~_ "and Cntfl ff::_Xlmllril 7-dr,' aVl,9agC OI Sf~ITr]'i n1.CSl ICm CP'~. Obt ;nlc' (t!1 ~i G
<br />monitoring pcrio6 under "lvt~xinnmr.")
<br />6. 3r:~r';°,•„ai1R-.lui~~;r7_:r'foreaehparamet:: undo; "~ir~,.i/,"a.:"'~r,~lin~"c~specifed tp;r.rR.
<br />7. Unger "Id.. 1-: r" enter Itu,mh~r of ~::mite i-casm L-neat .+c;^~ ~~-;r:ro.i'tg ,:,,~= nd I..[' . ~ ~ ~•i n_.a.'r,L .r. (e nd•~_r ;n'n~.-,; rn
<br />ar 7-day ve ~~o;, as tppropria[e) pcrTni: regn:rc; tent f„r ~.:~~c!• prr n°t~:~. If none, eut~: "C"
<br />A. F.mcr "Fre;%.~~n_i'.f,?:;~1~•s.' "boot as "S ,;;r'_ ir,'.r. ',_~,.:,~," (cctual frcru.:cy ,1~'s., np ag a-d m,~ysis ascd _r--ir;
<br />mc-nitr,~n~ rcriud) sm: as ": V;r,;%r R. ,nh,~r: --1t":naciGLd in i cnn~~. (c ~ . ~~I:: .~..r, ' .'nr ~ 7nt~~ noes monib~,i,-r. ;/7'
<br />f.l: arc day p~• v;ce!, "l/30" for one day per rranth, "li90"for nnc day per geanc , _.)
<br />9. ,.. ';S_,~:;•7,7)x•"hoot as"SJ,;7rle,i:'c-:7:._,.._,:~"(r:t~lalsrp;,t;i:c~_scd dun Pm,,~i:_~njr_ricd;arc:4s"i.,,7,'r
<br />Rs.l.tir~„,~ r{" {r.g. ':rte- "Gr1t" for indi~ ~dua! szmpL. "?4//~" for 7•;-i',o~~,r ern*pesi[e "^%.;" for conl`ruo.e.
<br />monitoring, etc.)
<br />l0. `.'J!tere violations of permit renuircments . r, rgw~,c', a7ach a brief c~pl; nr,lion tc c:cscribe cause aad CU?el'~~VC actions
<br />Ip Lc taken, and reference each violation by tlatc.
<br />1 ]. I' ", o discharge" occurs doing mcvi;o-irg period- enter "117o Dischar~c" zcross fn7~-I in plzr. of ~1ata entr'.
<br />17_. Enter "Name/Tidr rj?7•r,7.~irar F_r~__7dir: ,fj%_,:,•• \cith "Si;;77~rur~ rj rr-u;.:y_77 F.rs_:!iv: !7,T_,_•r rf ~iut;.+;ri~~J
<br />~:br7u, ""Tr(~p&or7a Numl~zr,"and "Gsre" at bottom of form.
<br />13. Mail signed Report to Oi;tice(s) by date(s) specified in permit. Retai^ copy foryom records.
<br />14. \4ore detailed instructions for use of this Trs:h~rgz rLl.;riroring RaE. ;; t (DT•7/~ form may be ohtnined from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />Tfris report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure [o report or failure to report truthfully can result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not [o 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 />
|