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iT~.~~erwork IZe~~~~io~. Act Notice
<br />a
<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 ] 8 hours per response, including 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 3raach, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Vashington, 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 directed at entry of that information akeady
<br />preprinted.
<br />2. Enter "fermit!ee Namt/Mailing Ad ress (and facility name location, if different);' "Perini! Number," and "Disc(urge
<br />Number" where indicated. (A sepazate form is required for each dischazge.)
<br />3. Sntcr dates beginning and editing "Mcni!nrirra Pe+•icJ"covered by form where indicated.
<br />d. Enter eru:h "Far~met,~r" as specified in monitoring requuements of permit.
<br />5. Enter "Slurp/r ,bL•~surans'nf"data for each parameter under "[;rlntity"and [ht1Yr,~" as spcci iec. in permit. 'Ac.•t"ae>2" +S
<br />runnclly anlhmetic average (geometric average for Lactcrirl parmcters) of all ~n:nple mczsrrcrnents for each pafamet~r
<br />obtainrri d+uin~ "rtf^ni?-,ri~to Peril'; ",~1~~-.iuttuu" and 1.9i~enuun" are notmohy c:urame 'tigtt and law mea_su,eme+;ts
<br />oblainec; during "d1 ,ni1• rirt~ Prri;d". (Dote to n:ur,icipals a~i!b secendap' treatmrn! r-Lirt:mert E";er 3D-day ate-ogc
<br />of;cr~pio mrsurcrr~cri~ u*tder "A•.~~r_oe,"a,td enter n,.:uiinum 7-dad average cfsamnle mezsurcrn:nV oSteir~ed duin
<br />monitoring period under "!/r,uimw;;.")
<br />v. I'.nl:r":.;;t,i!f,,./;:u,:,ns.1"'.oreachparnxt,rund. ";:-~~,~ri:;"a~_i"j~r~/ih,~"as s'ci!ict;inpcrri'.
<br />7. L'rder "11'. !' " r•°,t:~ cumhe- of sa.nple mrusuremenL :'crisp, ~nonll ,,ing f.~rind t`.al cacced nu.nn~m (an;l/ur m%n~~num
<br />or 7-day avr.-~: ss tnttronriwe) pcrnit renoi enroll fat each ptramcter. !f no tc, en.u "0".
<br />8, rn c- "F,e>~•:.r ; ~j,;;.~/ps:,"beta as ".S_.,,~'z '~:'~ n:,; ~,,;.,r,.' (aciuul Gcyuerc, r"~mn lire and anel~s,s used cic~-in~
<br />Todtonng pet~nd) s,nd ss "/'_.,,~%r 17,.~mi.~„t ant" s~e~ ifl~d in j;c tni'. ~c.L. Fr;~r "" n!,' gar con+~n_~oa manircrii,~, "//7"
<br />fr: one dap ps weu~, "//30'' for one dzy ner month, "1190" for un.: uey fcr yum5cr, Cii.)
<br />..m ,,,. ~ n i~jlt .d rti rind In o -
<br />tl_r "S t G "y~z" holit as ':S_,,; ij is i., -..c 3~,r~nt" (..cb~al s... rlr , vs ' onitorin~ p-ricd) : n~ z, "r •.-.vi'
<br />f~•~trir~,n:m,' (a;;. °.nicr "Groh" far indnid~tal :~~rl„ "141l~" fcr Zh-hc:: cnmpcsitc, ".t'/,4" ror con'i,uars
<br />monitoring, etc.)
<br />IC. t'r,_.c viu!rtit,,s of pcrzrtit requiremoYS arc rc~o;:c.:, ar!acU a h~ef e'nl~oatio~ to d:sribe cau~c and ecrrective scions
<br />to Se ta!:en, and reference each violation by dare.
<br />'. t. .""nn discltev~e" occurs dung monito ing period. enter "~to Dischar~c" ac~nsc fors-t in place of elata c-~try.
<br />1"_'. Enter "N~rte/Tide of Pr:~.t.:iF~! Erna>tit~ GJii.:_, 'with "Sienaltu'~ rf Pr%uri/d Ex_~rrtive :~_'er of tits;:~.,ir.•1
<br />A,~eu!, ""Teleplrou: ^4rmL cr, "and "C~ r~ " at bottom of form.
<br />13. AAail signed Report to Office(s) by date(s) specifiui ~n pcrnri[. Rcfain copy for your records.
<br />14. ivto[c detailed urstructions for use of ties Dis-h~be rLlonitorina Rzpr.t7 (Cia~ farm may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />71tis report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.2'1). Failure to 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 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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