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Paperwork ~:c~~axc~°~n Act Notice
<br />Fttblic reporting burden for this collection of information is estimated to vary from a range of 10 hours 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, 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, 401 M Street, S.\~/.
<br />t~/ashington, BC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, 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 "Permirtee Name/Moiling Rddress (and facility name location, if different)," " Pan»it IJumFer," and "Discharge
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monilorinb Perim" covered by form where indicated.
<br />4. Enter each "Farem azr" as specified in monitoring requirements of permit.
<br />5. &n!er "S~,nG(_ ,11rt.rru-ems,at"data for each parameter under "~u~ntiq•"and [itvlin•"as 57CCIfiCd Ll pCZnlt. '.'tVLr=ea'~" is
<br />-~rmally n~rhmetic average (geometric average for ~aaerial parameters) cf all sample measurements `or each pr.reneb_r
<br />obtained dui ir:g "r1-/ nih,r:%,r~ T ~rio.1'; "b1~~.ir.+enr" and Giininrrm+" arc normally :arr:nc hig't and law measur, rcn's
<br />oblanud du~iug ",.i~.nu•,-i,ra fzri•, l". (?Cote to ntur.icipals vriih recondar)• Iraafmcnt i.:luiiemcnt: Crlcr 30-day ::verc~a
<br />e'sa•nnlc i*:_r;urcmcrts ender '' , •~r~~_," a1d enter .nrx~. wn. 7-day r.vc~cge of s, n ~ac mcasunmcn+s obtairu:d c,~i ;;
<br />monitoring period under "efiezrimnm.")
<br />u. Ent:: "!"n,ir Rei,~iru,ne,a" "r.. eec'npanmetcr anel_r "' „r.t+! .,r.r.': "~rralir~"~ snceiicd.n re~-mii.
<br />7. L-.U.i ",.. ," enf.-rumba of srmnlc rntnsurem; m. d~-rind ~:r,n^':r, i~,g .~. ~:,d :'-~: t r~~.c-cu ma~.':,r~m (anJ.rnr min,-rum
<br />er 7 _!.} as c.,.• sa r:nrapr~ate) permit rcauir_men[ Gar zs~it paratncter. if -.or.e, enic "r)'.
<br />,. .'a.,: "'-r. „r ~r ; j A;ul~:c~ia" bo~'t -s "S.• ..r. ...~,ur~.~a..,_. ,., (cc. ~~I ,.'c: core, n" ~urr,plmp, ~an,l analysis ae~ dsrinp,
<br />more:nritgp~:r'cc'),;r,c~a~,'Tzn,riril:;uir:;+~•n~".piciGeciinpe:m~' (_.~.fntcr"..r:."i~trco~,t~.uoun,onliorir~,"/~7„
<br />... rntu da~• p_r r: •:c'' "1/40" fn, nne riav p:r month, "1 /90" fc,r nm- dry pcr r,u;~r.,;r, r b'.)
<br />S. ; n':r "S:,nE 1•Tj; z"bu L'? cs "S_~l.,r l_ i..,'~:rir."t,r ~,:i"(a^_t,al ssmi.lc type used cuiin~ mor.iloring -,ciieri) a:r.' as "f -n,;%:
<br />r, •~r4 ~,u_~+" (e.;;. 'inter ";hall" fcr individ;,al s r.i r:'_, "~4N~" fnr 24-i•~o:~ cmnrosiic, ";/.1" for cocN ~:•ecs
<br />monitoring, etc.)
<br />IC. ~: lure violations of permR rcquiiemcntc are cpoae~t, :rich a h: ic~c-m4 na+inn to describe ceose arc cc.-ecCve ue[i;rr;
<br />to be taken, and reference each viaiation by date.
<br />~ . °ino dfscitarge" rccu~ s de^rg monitoring perio%, en:, r "h'o fischarge" ecnrss for ~ in place of rata entry.
<br />IZ. 1in:er "rVJnta/TitL• of I r-i,tcir_~r F. r. -uliY2 Lei :~-" with "Sr;;rurte'd rf l'r-ir_ir. ~r /_'xt ,Rh_ ~iLildr of ftula;,'c=.!
<br />Ag,:nr, ""Te(eph ~n ~ Nur.:her, "and "Gertz" at Bottum of form.
<br />13. wtail signed Repcrt to O~ec(s) by date(s) specified in pcrrtrit. Retain copy for your records.
<br />(4. Marc cieiailed instructions for ose of this GiscGargz rbloui!orine R.l,r! /P.Iv1h) tarn may be obtained ;rom 017ice(s)
<br />specified in permit.
<br />Legal Notice
<br />'flus report is required by law (33 U.S.C. ] 318; 40 C.F.R. 125.27). Failure to report or failure to report tru[ttfully can result in
<br />civil penalties not [o exceed $10,000 per day of violation; or in criminal penalties nut to exceed $25,000 per day of violation,
<br />ur by imprisonment for not more than one year, or both.
<br />]'sPA Form 3320.1 (Rev. 03!99)
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