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PaY~~-~~~~rk Re~~~~i®n Act 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, searching 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, Infcrmation Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washingto i, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />~e~.eral Instructions
<br />]. If form has been partially completed by preprinting, disregazd instruction duetted at entry of that information already
<br />preprinted.
<br />2. Enter "Fermiuee Name/Moiling fiddrass (and facility name/lccation, if di fFerent)," " Perniit A'utnhvr," and "Discharge
<br />Nurnh~:" where indicated. (A separate form is required for each discharge.)
<br />3. );nter dates beginning and editing "dlonitorirr~ Period"covered by form where indicated.
<br />4. Enter esch "Pe(vurstar" as specified in monitoring tcquiremeots ofpermit.
<br />5. Enter "3~r,rp1~ tLis~sur~m,nt" d,ta far each parsmcter under "'aurttiry" and ~nro7ip'" as specified .n pcrrri'. 'Ave:sae" is
<br />no,-mal'y arithmetic average (l;ccmetric average fur lmetcrial parsmciers) of a!I sample messwemccis for each parrmeter
<br />obtainer; dt.ring "/VL;n'',n,v~ Pe/iod'; "ivil;ir,nun" and 1,'brir;runr" arc normally extreme higl• and low nteasur*ncnt;
<br />obtained d.Vi~g ";~t ;ui.ri:ro I_ri;1". (Tiotc to nrw,ici;;:ds c:iih serondaq' treatntcnt rccuircmcnt: Fntcr 30-day average
<br />of san},lo n-wesw cn-::~•~!, unCu~ "~; ver~~ ~ "end enter maximum 7-day avuaoe of sample mcaa~remwts cbl~incG drain
<br />monitoring period under ",LiaXirtertt.")
<br />u. °m. r "/',r,-:ait R.:-;t•ir~/:r_at" ".r tacit rarumet:r ~.:au_ "'.vl,;tif;~"2nd "L allity" ac sr:rci~ ed is permit.
<br />7. Und~- 'i:'-. F: " enl<;r ~um6er of gGm ;lr. na-!euicment Owing n;o~ ';n ink ~~.ii of :' e: csc~ed mm,intum (zrd.'rr ntinim,m~
<br />or 7dq~ aeeruli: as t ppru;trial_) pu nit rc.}u ~-nen! rc.r .ac!! arumeter. If nr.ne, cote; "0"
<br />P. [nu.- "Fier;r-,r_~ !J.in~h e%v" I-cth as "Cl~:,,-i, '.d -rs,/. ~,,. -/;." (.:coral rrcyucnr„ or ste~F;~ng and analysis ascd 2 ern,
<br />muniloi~ tg orriodl ;,nc, as "!'~,~,,;it,4t-;lrir_~r: •,:,"sr.rrif:~d in fe,mit. (e.g. Enicr ".,~.,r(,"torcont'nuous monitorng, '7/;'•
<br />fe; nne o.~y p_: tvcck, '7/30" for one icy rdr mun!h, "1/90"forme clay per quar!cr, ate.)
<br />4. ':nl :r ".S./;,t _~ ;; _"both as "S~nrFL ::.t.,rr. a ; •,~ .' (aCt_al s:_mple lwP~ used curing inoni t:ring period; az~L as 'Ta-l;rit
<br />l~•~ui,u,r_,a," (c.g.Ftler ";.'.F" fnr uxlividual sampl_, "?~'il,:" fnr 2o--hour compo:.it_, '?:%'" for continuous
<br />monitoring, etc.)
<br />10. tx!c:ore viul~tinns of pemit re~uiremcnts are -cpnrlcJ, a~taeh a c:ie°exlilan.:+ion t~.~ d,.nihe cazwe and ecrrctittvr ac[io is
<br />to he tal;c~, 2nd reference each vio:ation by data
<br />' I. I' "ro d'schzrgc" occurs durirg :noni'ur;ng pcru~', cnt~r "~!o Disch;:rg." across four. in place of d. to entryr.
<br />IZ. Emcr "Nar.r_1Tiltz ~.f Pri: z,:iE _rl i:'_•..uri nd '.Jfi _ 'with "Sid-n~turr of Prin_i! ~l F'x_~_laiv; ~~~er of 1, tr ;'n,iz~d
<br />~:gsnt, ""T~kpha+a F!urth~r, "and "~'JtL" at bottom o f farm.
<br />13. Mail signed Report to Ofi<ce(s) by d~tc(s) specified in permit. Retain copy for your records.
<br />14. Ytore detailed instructions for use of tfis Gir,:ha/ye ,L1a(irorina keFo,7 (L;:-IR) fei7n may be obtained from Ofiic•_•(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). Failtue to report or failure to report truthfully can result i^
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties no[ 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)
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