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?~~~erwork Redaction Act Notice
<br />Public reporting bwden for this collection of information is estimated to vary from a Lange of ] 0 bows 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 18 bourn 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 3ranch, PM-223, U.S. Envtronmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office of Information and Regulatory Affai> u', Office of Management and ~,
<br />Budget, Washington, DC 20503.
<br />general Inst_r~?,ictions
<br />1. If form L?as been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pennillee Name/,L1ai/ing Address (and facility name/locatien, if different)," "Permit Number," and "Disdturge
<br />Nrrmher" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "ivloniroring Feri%d"covered by form where indicated
<br />4. Enter each "Partrrn ~t~r" as specified in monitoring requirements of pemrit.
<br />5. Enter "Snnpl~ rLf_•~szu _•+u%nt"data for each pa+mmeler under "l~uarui!)~" and Qu1l~m"as specified in permit. 'Ave: -'o ~" is
<br />~~unnally arithmetic zveragc (geometric average far bacterial parameters) e~f ell s~nrpir. mr;,tiuremcnis For each pnranre:cr
<br />obutincd during ",Li-ui!srine Fri:d"; "1L.~ir:uarr" and blinin!rnr" an; uo-malty ..nr.n^c Fig; and !ow mcasu-e-;rnts
<br />obtained du!iog "L'.n;i:,'i,te Prri ~J". (i~`otc 'c rounicipals c:':h scconciary treatment r.;-u rmcY: ~n:cr JO~ay avc.zge
<br />uCs, mn'c n casuremras under 'A~.~_+~~a," m-d entry m. cint:~n 7-d:y average eFsamole mcascre,nc~~~s obtained c:_ri~L
<br />m un i Lori ng period under "iv.'aximwn. ")
<br />6. _:mer "1'_,vnNlZ;,ur,:m•.:r" or each parameter cnd,~ ";,.ur.>itr"end "~u~lif),"zc spcciGed `n p.rr?it.
<br />7. 'V ilC~i";.'-.E.."nnttr.number of san,le meas.u_r~rn~during n,o 'i?~., ,.c-~nd''.!~._•cd min :mrm (and; r.r mi.,'mu.n
<br />c: 7-d.~ avcr~a ss tppropriatc) permit rcou~ cmcnf Tar rack oaramrcr.Jif none, cn:c. "0"
<br />S. S,n,tr "Fr,., -.~;~ •f.Lulyvic"L'uth .,':5...+,•L 1:.•nt•~ ;+.•,u,. (oc~-urn ~ieoucrcy . ~',,,niir~ -: ana'ysis _~sec; ~sr;ng
<br />m m,ilui ~ tg pn bd) an; as "F_,-„.i/ k:- ui, .u,.u+„ ~nrciued 'n ite,-~r i'. (e.g. t:„f.:~ ..,,t`„ ,,., co~tr; .iuo~s mom.urirg, 'V7"
<br />~~ r e~.?e day peg ?:•:e4, "1/10" fur nnc day per monlit, "1/90" .ur one day nor quarter, e'c.)
<br />4. Fnicr "S;,r,; : • T:;-. "SntL as "S"nF/~ ;1.'~wa errJ.u"(.dual :ampl^ typo '.~c_d dui ing monitxin~ r.ericd) ..rC as ". :n:;;,
<br />2•.Iri.z+nu.,.," (ag. l ntc~ "!;..,1'" for indicidacl c:=r'no~c, .'n4r1~" fcr 24=,c~ ; u~~posi[e, "^.%." fo: can ~nuot~s
<br />monitoring, etc.)
<br />10. !'"-:ere ~~iolnCc~ns of, unit regtr rem%nb; are -c~ortcr, attaca o b,ic,'c:; lenaiiu^ tc d_,ti~bc ears' an CC :C_.:VC aCIIOiLS
<br />to'x tal;cr, and reference each violation by tiatc.
<br />t. T." "nu discncrpe" occurs during monitorinng period, enbr '"•.'n Ciscl-:urge" acros, form in place of t fta c-s y.
<br />:2. E:?ter "N_nrJl'iIL of Frirr„ip~l F'xewrlir_ .~i:r~" with "Sir;n~na•z rf Fr%r_i/ .' ,.._...+i~•u r.~_a~ ~~` Au!;.•,~i:_•1
<br />Ag~mr, ""Tzl~ ph~nz Nu.nt ~,•, "and 'Cats " at bottom of form.
<br />13. id ail signed Report to Ci7~cc(s) by date(s) specified in permit. Retain copy for your rerorda.
<br />14. 'vlore detailed instructions far use of this Ci?vharge ,bf,mitwiny R7 •.rt (Ii1vfR) .u. n may I:c uhtainad from OT;icc(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is requi*ed by law (33 U.S.C. 1318; 40 C.P.R. 125.27). Failure [o 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 mom than one yeaz, or both.
<br />E;PA Form 3320-1 (Rev. 03/99)
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