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~~~wrwork Red ~ ~.~aa Act Notice
<br />Public reporting burden for this collection of information is estimated to vary frrnn a range of 10 Hours as an
<br />average per response for Borne 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, 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 />I. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pennittee Name/tLlailing Address (and facility name/location, if different)," "Permit Aruntbsr," and "Discharge
<br />Numbei' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "tbfonitoring P~ri~~"covered by form where indicated.
<br />4. Enter each"Pavm'ter"as specified in monitoringrcgniremen[sofpermi[.
<br />5. Inter "S~nrrl~ d4_•ostr, Asa 'nt"data for each paame:cr under "Cruntity"and [ullrhr" as specified in perry it. 'Amur rgz" is
<br />rormal'y arithmetic zvemgc (geometric average fnr L•ndc~iol par,.meters) cf all s;n-.plc mcasJremerLS for each parumetcr
<br />obtained during ",1-L.:rt;ri,r~ l_;:2f"; ";~4~a'irrr;nn" ~,: IJinirrm.;" a-e nonnaiy carcrne'ii;h and'.ow measuremcrls
<br />obt~iney d+trisg "Il;•a,%L~i,;o tai: ±". (1`!e-e [r, mun cipuls vri"n cuonc;aq• [rwtrecnt rs,ui~cmect: '=.nter 30-day ave-a~e
<br />Of fiamnle li C.aSCSementc L'i.d Ci "fi `Jd."v"o'G," rL:i L:I tC~ ~'a;an~UT, 7-da}' a4eragC 0~ ::'IP', ~~C mCLS Jieii Cll:g Gbi~InC~~ dJnlaj
<br />monitoring period under ",Naxirun.t.")
<br />5. ~n:..'S~.'.Lllt/i.'~~L(G'8idld/nrnicachpnr.~mctcrundrr"~:•oatil,,~"and"`ur/i/,r"as s..;cilied rlp~'mt::.
<br />7. U~rdcl ';i'; F_r" cn'sr number of srm; !c nz2;crcme It ?a;ir~ ..m ~'~i-~r.~ p_riuI :'•~' i•~c..:'_ ma::i,num (rndiur m~ni:nun;
<br />or 7-day a~•era~_ is c~;propri:.te) n..m,~t req~i:umcu: fog each ?arom_i~r. ; f non:-, a~.i,,: ••("'
<br />S. .:nt . .`i-r, ;t.~r rf,ln~lj•sis" bofl; as ,- ,,,•L• ,.. •s, , -,,,_, ' fecoi. r r ~cey ,f ... npl'ny end. analysis ;Bed ~u-ing
<br />moni+nr~'~g period) cad as "'.•rn;i! R ;ui,v:,r_•+;'" s~c6fL;1 in ~~.en;~ir (e.~. l:-.ie: " ~•.ul,".nr Ca'~7!~AUC',s monlloi;.ng, "I/7"
<br />fe; one day p~~ r,~e'r., "!/30" fog rnr~ day cer month, "IiJU" for nn,; day per quarur, c c.)
<br />9. L-nle-'SS~r.•F/: T,,-'„hotly as "5,.,,rl/~ t,, :ur_•r~...~r° (cdPCl sc;- rir. t};;c used L:u in~~ moiito-in, pcrio:p anc as ",'r~-,i;it
<br />R•:juir_,,;;itr," (eg. '=ttcr ",i~af'' for indi~.irtual ;:r~~pir, "11i1~" `cr 2~+'•0•- composite, '-~1t/.i" for con±inuou
<br />monitoring, cic.)
<br />1 C. r ~"'.:re L•iolabons cf pcnnit requirements ar.. ; c~nr;rd, cttacir a L-riaf cxplanclinn to dz,cribc czu;e znd corrective actions
<br />to be tal:c.n, and reference each violation by dare.
<br />11. If'oo d scharge" occurs during monitoring pcr,oa; cnt,;r "~lo r; ~ccharLc" across fo.ni in plate o: da!a cn'.r;'.
<br />l2. Enter "vamJl'iN= ~f Priaai~ul Erznrtiia Gf•'.•sr~" tvi[lt "Si;~rah•,~ rf I'r%nar~l f'sz.u+iv~ ~aer oj~itrthsrizeJ
<br />Rgenr, ""T~lephonr Ntemh~:,"and "Outs" at bottom of Corm.
<br />13. Mail signed Report to Office(s) by date(s) specified 'n ptrntit. Retain copy for your records.
<br />14. More detailed instructions for use of this liis,:harb~ r+dorvitoring fZp:rr (D,t~ firrm may he obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report i; required bylaw (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report evthfully can result in
<br />civil penalties aot to exceed $10,000 per day of violation; or in 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. 03/99)
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