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~j ~ti~erwork ~L~`uciion Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 aoars as an
<br />average per response for some minor facilitics, to 110 hours as an average per response for some major
<br />facilities, with a weighted average for major and minor facilitics of 18 Hours 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 Branch, PM-223, U.S. Environmental Protection Agency, 40] M Street, S.W.
<br />Washington, DC 20460; and to the Office of Tnforrtation and Regulatory Affairs, Office of Management and
<br />:3udget, 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 "T'eG-mittee Nanle/Mailing Addrass (and facility name location, if different)," "Permit Number," and "Discharge
<br />Nwaber' where indicated. (A separate form is required for each discharge)
<br />3. Enter dates beginning and editing "Monitoring Perioy"covered by form where indicated.
<br />4. Enter each "Parametn-" as specified in monitoring requirements of permit.
<br />5. Enter"s:rnp/~n4~s.crn~zGnsnt"data for eachparame;crunder"~rr~ntiq•"and~z!~hh~"asspe.;iFec'inpeznit. "Ar~._rb:"is
<br />norrnzlly arithmetic average (geometric avcroge for bacterial parameters) of ail sample mcast re:~tents ror each parameter
<br />obtained durir.~ "•b' nir:rin~ Prri.,!"; "'./r.bnuur" any i„Lli:n:nu" arc noanally c..~ _,ne '~iltt ar.d low ^~eacu~r tents
<br />ob4.ined dui.tg "A!.t,;t•,hrb Parini". (Nrte to municipals n^'h sccendary treatmcn/ r: ;t:;ement; Enter 30-dry ave-r.gc
<br />of sampru meaerrcmr.~s ur?,;r "Avara,;r," a^.d cater mzrimum 7-day average o's:~m::';, r:: ~su•~ ..nts o;tl.-inc? d nivg
<br />mcnitoring period under "ivlarim:a:r.")
<br />o. Enter ';',•nait 2;ar.•ranznr" nor each pam~ntutar uncic: "[,r ~,;; i! •"and "i I!a/ihG"a5 S 1 CItICG II j:: r:Til:.
<br />'1. Jnder'91re F,.t'' enter number of sanclc ncasurement d: ring r.-:~~~~t~~~=r.~ n~c :>' t~.~ _xc~cd ,-,c~i,nan (rndior mi ti:run
<br />..r .-dcy average: ; approar.ate) permit req•~~rc~~n.-tt Fnr cac'+ p~raneter. 'Fnone, ente. "G".
<br />It. Amer "Pr_•~r ~u:;: ~.G`,!,vlrsie" boot as "'_~..;• ! • '.;.~c r_,,, •r•" (aciurl frc:;~ eery c` se.m ing c^.d ana!!sis use:; dv*in;;
<br />moni'r;r::g p;i:od) Snd as "I.,,•?it 27eir:r:~ •ta" sp~d'lcd in pci~~: ~ (r..g. !'~±r ~ .:~;. fc-ccat: ;•~cs manitorir•, "t~,"•
<br />fir one day ps v:cc!c, "7/30" For anc d<y per rr.amdt, "!r40"far anc day per gt,aCC, u~:.l v
<br />C~. ,'.ntcf 'J ~/il^'d T'~ '"ate Y;t cs 'Sa,:rF/,: GL:•,7 w.r a,.I_.u" (aacat sa-,p1~ ty~~ u,~d dt~ria~ :r.~~t $ct~nj, n-:iouj ar~d as "r.~nni.
<br />ii::.1lrir2rilant," (c.~. Cntcr "O.vi-" for ir•dividual sanplc, "?4/; _" fur 24-'ta ~~; ru,r,ppsi tc, "'.7.."' ror co^tiovc ~s
<br />monitoring, etc,)
<br />10. !',^•tcrc violations of permit rcc!uiremrn's me rapertc 'i at'uach » L•ncf CXplL ilaitOn 10 ri:SCabC C,1115~ in:1 Cori e]iI VC aei~G05
<br />a be takee, and rc;erence each violation by date.
<br />t r. if "no discharge" occurs during monitoring period enter "No Discharge" acros.: form ut pima o"dc!a eclry.
<br />12. enter "A'utnz%fids cf Trirl~it'.J Ez_.-tttir~ :ff_ar" c:iilt "Si; ,r~tvr~ r,J frirt_•ir:~r F,rc_vriv~ G!j`i_.r r~` Aurh;;ire1
<br />lgrnt, ""Telrpl:-,n~ Numh~r,"and "Gals"at bottom of form.
<br />13. Mail signed Re;tcri to Cfficc(s) by date(s) specified in permit. Retain copy for your record_v.
<br />13. More detziled instructions for use of this Gi.r=haGga GL1;nitorino Report (GlARJ form may he obtained from OI'iic::(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required bylaw (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 />or• by imprisonment for not more titan one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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