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~= tiz~ 5~work ~~~ ~ci~g~~ Act Notice
<br />PuUlic reporting burden for this collection of information is estimated to vary from a range of 10 hours as an ~
<br />i average per response for some minor facilities, to 110 hours as an average per response for some major
<br />f~.cilities, with a weighted average for major and minor facilities of ] 8 hours per response, including time for
<br />reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
<br />i 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, 401 M Street, S.W.
<br />411ashingtou, DC 20460; and to the Office of Information and Regu]atory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />~neral Instructions
<br />1. If form has been partially completed by preprinting, disregazd instruction directed at entry of that information already
<br />preprinted.
<br />:.. Entn "Fermitte~ Name/Mailing iiddrzs's (and facility name location, if different)," " Permit Number," and "lischorg,r
<br />Numt•er' where indicated. (A separate form is required for each discharge.)
<br />_ . Enter dates beginning and editing "idonit~ring Perio i" covered by form where indicated.
<br /><, Enter each "F~ranm!^r" as specified in monitoring requirements of permit-
<br />`. Enter "S1r;rrl ~ AI_vsurrm~nr" data for each parameter under "~u~r,!iry,"and Qrr.~lirj "as specified in permit. 'Ava,;roe" is
<br />non-naliy a~thmetic average (geometric average fur bacterial naza~reters) ofall sarnptc mcasuremen_~ for each parainefer
<br />obtained during "AI.niP,rine Fari:J'; "i~;.l.in!wn" and ~::ini,.rrr;:" arc nommlly ex~rcmc high an6 ]on meatim-emcnu
<br />obt¢ined dtim,; "ll•.nit:r~,;;; P; rive/". (mote to raunici{tals wi''n seatn;nry ucatmc~~ raqu rcment: Eitc~ 30-day : ~c^ g~•
<br />of s~npte m~rasurcmenrs under "~lva-,agz,"and enter masimun 7-i'°y ava~ge of s.:.-~ple mestremcnls oLtrined du-irb
<br />monitoring period under '4Lh~*.i„uun.")
<br />6. I;r.cr "/',:r,.%! F.7;uir.•rr,u !"for each parameter wider "Qv~nti!„" a,.:: "~iv!!iry" as s~ccificd i t pemt'.
<br />,. Under ".J, i=~" cn t:r nemccr e:'samplc m.: c5un m-cn; ~~:ring nvniot~;.to ;~cri,:d th:~~ ,-acccd maz'm um (snd/nr nti ¢f•~wrn
<br />or 7-r'_::y overage es appropriate) pcmit requiremcr,t foi each prmmetcr. If none, enter "0".
<br />F;. .:~r_- "1•r_;w •n ;, ,y'n,u!}'si "hoot es ""_~,r, I-~ :~' ~cer:,,:..." ;t!~~'+.' i*~o,c_,icy ur •.;~iplvt~; : rf anriysis ;used durii~~
<br />mnniioriag perod) and 2s "Fee„ui Re;ri,~w_r::"specified in f,Lr.:ii'. (ag. Ord%-'• r' "iL: ca ut'tme~s n'onitorin~, "I/7"
<br />for one d-y der tccc'c, "1/30" fu: one day pc: montL-, "1/90" fur oce day per quartr:r, ciC-)
<br />i'. ".ntur "S„nt!. I}~ ~' bath as "S ~c,Hle ria.+s+n~~nr ~ni"(actw,l an :ple t3; ° rsed du'ing mo^itnr:n;, p_-iod) zed cs "ra,,rr
<br />Rtgrn~.:,~~;,'," (e.g. _ ::cr "Grvt" far ir.dit idol srnplc, '?dh'~" ,`rr 24-hum co~npas te, 'Si .", for continuous
<br />monitoring, ctcJ
<br />10. !;~:ne vial.aiors ofp~rrit regcixments arc raparied, aL~dr r 5r~fet:plW:aLia.t to c:cscribe cause and corective ¢c:io~zi
<br />to he taken, and reference each violation by date.
<br />] 1. If"no discitargc" occurs daring monitmirg period, enter "'r!o Discbarl;c" across furr^ i^ place of data entry.
<br />12. Enicr "Nar,r~/Titla ~j PrinciT~l Era, mic,; Q~_•a-" tvitir 'S~,n.er, ~ of Fran. ii _ ' cx_~,rlive O~uar of ~e!;vrized
<br />/i;~nt, ""TeleF;rnr A'wnh~r, "and "I %at.r" at bottom o f form.
<br />] 3. \4ail signed Repcrt to Office(s) by date(s) specified in pem>it. Retain copy for your records.
<br />I r.. ;vTure detailed instructions for use of this Dis~har~~ M•,ui~.ring F ;-~,t (Giv,7~ for;n may be obtaiocd from O~cc(s)
<br />specified in permit.
<br />Legal Notice
<br />"'his report is required by law (33 U.S.C. 1318; 40 C.C.R 125.27). Failure [o report or failure to report truthfully can result in
<br />t ivi] 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 />I:PA Form 3320-1 (Rev. 03/99)
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