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~~.x~ ~:~r~;~~: ~~ti~:~~:~tion Act Notice <br />Pu'ulic reporting burden for this collection of information is estimated to vary from a range of 10 hoots as an' <br />average per response for some minor facilities, to ] 10 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, seazching existing data sources, gathering and maintaining the data needed, and <br />completing and reviewing the collection of infornation, including suggestion for reducing this burden, to <br />Chief, Information Policy Branch, PM-223, U.S. Envtronmentai 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 />3udget, 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 "Permi((ee NanJivlailing AdJress (and facility name location, if different)," " ParmU Number," and "Discharge <br />nrun,t•er' where indicated. (A separate form is required for each discharge.) <br />3. Enter dates beginning and editing "Mctri(~,ring Paria/"covered by form where indicated. <br />4. Enter each "Parame(a•" as snccif ied in monitoring requirements of permit. <br />5. Enter ".S~atFle rYi~zsvrenrar("data far each paramcIDr under "~u~ntiq "a+td ~ruali/)~" os specifcd in permit. 'itvtragz"+s <br />^ornally ari[hmetc ~ vcragc (geometric avrrage for L-aaerial paruncters) of all sx,nplc messuremr;_tts for each parameter <br />obtainul during ",~i:,rr~,rinS F.ri,~'; ",ld_r.ci;:nr~n" ::rid bliainamt" are normally ~:n~e~me l igh and low mea:.u'emcnts <br />ohtainec: wring '-~; .,Jr„ iao I_;i-;./" (Note 'c muticip,.ls wi,h seeondnn~ treatment rceiuiremnL' '=pier 30-day tacrn~e <br />of ti: mn~c m~asureme':, u~ccr "~;?•rs,;_ , rid enter rn.^;~I: ,rr 7-w.}' :.vera;,~a cf sa~m; le mcastremcnts o'utained d:ni,:g <br />monilorng period under ",Vilxirnnn.") <br />E. ' n' r "i ~„rri+Rs n•ir,•r,~~r!" ,ur each pal-arrr: er and°. "z ,_nrih,•, r,ni " ruli;~" as s;,cci: ied it perm;. <br />7. v„ ;cr "i!;. Fr" entryr nun~bc. of .,:u- i'e an~:,enre~~,u~' r; tiny ~~ ,~-'~~nin; n_rbd t. r..ec~1 men. imcm (enn~or :nin.etmn <br />cr 7-dry aver ,c 2s tpproprizic) p.nmit rcqu'r„Went fir .ach po::.n'etcr. ?`none, enter "G. <br />('. -n'.:.; 'rr-; ~,t_y ej•4uh,ers" 1:: (' a, '. -l:.'. _-.,, .,. •,r~" (ac!ucl fre:ncrc,r r..'„7tp'in~ rrl analysis sc1 during <br />m nP~•nri ,o I;cr'od).nJ as"^dr,,,ii R;; rt,-,,, _..r"sn~aful ~n rein!'. (c.g. i'rtU ' --,; rl, '' fur caul -,ucs monitoring, "1/T' <br />..: nc rl?•• per ~.~w'~ "//i0" G.r c ,e r;ay rn;r mnn,h, "1,40" fnr rnx day her qu: rt~ r, c'c ) <br />'. - n_r "S_,rrt'' TjE,•'l;nih :. '..°-„r,rl • ~, , ,,, ,,,,,,,, ' (a"l~al r,rmpir h,•fe'~~rrl duri:g morL~ri, nerind) are; as' T,:.,,,%' <br />ti.•1rirrntdn, (c. Weer J._ o. ~.~rc;,t•iG~l - p <br />," y, •~ "•-!- .' r ~,:;° "'~;r:' ;or 24-ho, can at tc, '•;::'.."' far con•ircous <br />man~toring, etc.) <br />10. ~~!'-.^re violet+;r^; of diem rt rCOL]rC.]L' l:5 ~'. iC~ a: it t~, ; :',7C'1 a i-fl C'r C.( l~r n311o : LO U.iCn to C'au b. ald CCr; C;aI VL aCi'o ~5 <br />:o be taken, and rcfemnce each vialation by date. <br />I'. I°"no disco: rge" cccu , di~~r;,' r,nai'crin~_ p~ria::, cc'...r "?!a Dl~rhar~." crass iorm in ,rl;;~c ~f d4la cnhy. <br />2. ?ntcr "rr(arvlTiflt c/%':'/.r_ir.:/ !::: -.t~rirs Gfj%:_,'' rvith "Si;,rr~4t;r of /l'%u-iF:+/ Fx._t~tii:= Ol~_~r• rf fiufhr.riz~d <br />kb~n(,""Talephoe= i\+um1.;r;"and "C~1_"at bottom of form. <br />' 3. Mail signed Repr!~ to OfGre(s) by lotu(s) specified in permit. Retain cop}• for yourrecords. <br />:4. 1'lo:r: detailed insltuctinns for use of t~.is Cis:b~r~;r, ;;i~,rritoriltg R>_j,r-I (CA:(R) fo,-n may Sc o'otaincd fmm O"fice(s) <br />specified in permit. <br />Legal Notice <br />"11tis report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). 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 />czby imprisonment for not more than one year, or both. <br />1;PA Form 3320-1 (Rev. 03/99) <br />