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1?'~:~~9rwork Red ~ ~tion tact Notice
<br />Pablic reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />a~rerage pet 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 dzta sources, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of information, including suggestion for reaucing this burden, to'
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.'
<br />Washington, D~ 20460; and to the Office of Information and Regulatory Affairs, Oftce of Management and
<br />B'adget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pernittee Nance/Mailing Adyress (and facility name/location, if different)," "Permit NumL•er," and "Discharge
<br />Num(-er" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dams beginning and editing "til,nitoring Perio.A" covered by form where indicated.
<br />4. Enter each "Pararrstzr" as specified in monitoring requirements of permit.
<br />5. Enter "Semple Adslsurorrt°nt" data for each parameter under "~'u~a1i:;"end tvtt3lilr" as sped ied in permit. "Avar-rti~"u
<br />~-:ortnally arithatctic a•: enge (geometric averge fo; hnrterial parr.mcte~s) of zll sarr~plc meast~remart< for each parrmrL^r
<br />obtained duri~~g 'S;•lc;rit;r%a, r"~r%;1'; ":!i.::i,au,n" ,.r' !~(nt%:.uo.;" an: nwn311y o,:.r_,nc high and lot, mcasurunert,
<br />ohtoinari du-i-~ "i.Sa.;iMri,tg r~ri ;j". (A!ote'o ~mm;cieah •,r'h seccnr~,n tr,:aGnc"t ~~-:uirr.ne-,t Enter 30-day aocr,:gc
<br />of ;amp!c rrtasurcmeniti c,d~r '.:v_,-a~s, and e~tcr ..r:a'mlim 7-d:} averaga of sc~r;'c muas.ucncots obtained dnri;~I;
<br />monitoring period under 'Si;;lximum.")
<br />@. °_ntr,~"/'.•;~nitR•Irv,:.,e>.~a"'',,rczchparamc.cruac:.: "Irv;,t.t/;."z^c•"Qt,,~ri~.'•zs.c-,:ci~ed inpemi.
<br />i. Undc; "i\'•~ Fs' ent,: -~u iucr of sa*rnic m^na.ue:n,.'t grind r~nr 'a ~;no a_.iod t' at e..c.:ca r* a-:mum (s~"iicr minir,tar.
<br />or 7-dg ar•e:~ ga a:: a;:proprirte) f._nni; n::{ ~iremcn; "c* rzal! pn-ar~etcr. i f Wore, enter'(!".
<br />e. ^.nt~.. "F. e;r'_, • j~ ...alpcis" both .. "", 1 • .~; ..., ...,_,•~" (ue:cc' F~.r. ucncy •,f , .~~,r,-lirg a ~.d znaly"`s usc3 r~s.~•u•
<br />man; ,:r+ ~g na=od) ~- i. rs'T,~.,.u' Rc~r~i, _,~ ,;rt" Sntr,Gcr~ '~ ::rnri•. ;; .g, !'; t.- ' "'rr mr'i•,uo~s ~r,aritorro "t/7"
<br />'er nx day j~_- P: ee',~, "//30" For one d:.y ys m~,n'C "!/)0" fo• ors c;a}' per nua.tcr, c,~: 1
<br />.. =:n'.,r ".5:: 's Tj,:~" tct; ._. "S ;n~/: ;,...... .. ~, r" (. =t,,ct . ~,:n~c t};,_ .,-~d swing ~ ~~i:c inp. ,c:iou) an : as ", ~,-.,n•
<br />2•lair•.-ma.d," (e.g. E-rte-`"c;.vL'' fcr indFrd~~al .:rn-~,. "_arl;' fc: 2d--c_, ccmpo.itc, 'i:'/f'" Cor contin~~cui
<br />monitoring, etc.)
<br />1C. ,'here t~olaliurs c" iJE1T:`. requirnc,.'s ;,.. •~ c'ad, aa~^ch a brief ~ cp': ra;iu- to c:_scrihc c_usc and corcetivc acucns
<br />to be taken, and reference each violation by date.
<br />11. If "no discharge" occu,-s during moniteric„ period, enicr'T:o Cisclmr~."suss fa'r* in p!acc o`data cn*y.
<br />12. enter "Nons/Titl= rf !'r%n~-~ s1 F.':,~utit_ :f,F .r" tvillr "S ;:i:?!r.'. sf fY~in,h ~' £s.;.~u%t•~ nffi.a of !ur(r'.;~zu'
<br />!rk'nt, ""Talrp!»nz Nu +rF~;~, "and 'Tl>_ " at bottom o f futm.
<br />13. Mail signed Report to Offec(s) by date(s) specified in permit. Retain copy for your ~ecads.
<br />14. More detailed instructions for use o` this Cis~;tar't;e i.1~,rir-.ri;rd R:r~,rr (G'dR) form may be obtzined from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />''.ltis report is required by law (33 U.S.C. 1318; 40 C.I'.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 />or by imprisonment for not more than one year, or both.
<br />1:PA Form 3320-1 (Rev. 03/99)
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