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~~~~.~ rwork ~ew'~r~~io,-;< Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of ] 0 hours 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 hours per respoase, including lime for
<br />reviewing instntctions, searching existing data sources, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of information, including suggestio^ for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 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 akeady
<br />preprinted.
<br />2. Enter "Pennines Name/M~iling Address (and facility name/location, if different)," "Permit Number," and "Discharg„
<br />Ntrmhrr" where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Peri : /"covered by form where indicated.
<br />4. Enter earl: "P(/rplrt~ldl"" as specified in monitoring requirements of permit.
<br />5. Enter "S_rtnpL .if •l.car.»~at("data for etch panmcter under "['runtiq-" and Diu-r!%q~"as srecified in permit 'Avzruoz" is
<br />-,o~rnally arif,mniu average (geometrir, arrrage for bacterial parameters) ofall satrple measurements for each pa~m;;icr
<br />obtained duri;g "6I nir,r%::o Faris,!", ";11~~:inrrrnt" and i~iinimum" arc normally e:a~cme high atd 'ow measure;-eats
<br />obit~ined. during ',/, .ntr. ;,;6 F. ri~l". (mote to mur~upals wi~Jr secondary treatment reeuircmc•it: Enter 30-day a~,rragc
<br />V: q'i^,71c mcrsa~emc~t, urcer "A~erloe,"and enter ~aaeimum 7-&~y average of>ample mesurements obtained d~uiing
<br />mcnitoring period under ",Lfuimtrm.")
<br />5. .':nl. - "P.• gait R.~;t•%r_nts,d" or each parameter unrlc "~.uu!ily ",.n;; "~a~!iry" as specified .n perrnii.
<br />Z [Lids ",. F. ~." e,~L~ number of sanple n~cs, urc-neat dwing r;unii„ ing t-~^nd "a: c•,uxd ina; ~mr~m (and/or min`mum
<br />c ~ 7-di~y avcrz;,.: es appropr ~c !'c) p.:mit n_qu~~remcnt fur each pan ureter, lfnune, en to "C".
<br />9. Ga.-- "I~~- ; ,~ ~• y',",ul,~•s%s" bet-, s '.S-•.:.,-4 ~~C•.nn~ r,,..~~tr" (rcnia~ fi'cqucccy a' ,ampli,-g aed ana:ysis used during
<br />men~tui',o ner~nd) an ~ as " ,,.,,.. k •.~r.ir..;~ ~tv:"specified .n cenni'. (e.g. t:ntcr ".'cnl,"rnr coat,~uo~~s n-,oniterirg, "!/?„
<br />2r nnc d. y per n•cc':, '7/30'''oi ooc day per munt~t, "'il(1" for ore day per quarter, c,c)
<br />- ,. „
<br />9. kni rr ".C~r,r . TF •" oaI'; rs f -,n~l~ '..'r~e:~.; ,.;_: !' (a_t,~l sa~nplc tyre ocr d drmr~ moorturuto ;-enocrj uu~: ~s - rr,,i!
<br />kd;rir. ~n_,~C" (e.g. linter "Grol " for ind vidoal ~,.~:r';, "1$.i": ''cr 7.4hm composite, ".~.%"' for con.inucus
<br />monito~ng, etc.)
<br />IC. ~?!'.':re viul:.tinns of pcnnit requirements _r.: reported, alia_'t a brie.` ezp'ana~iua to describe cause and correct vc actions
<br />to be taken, and reference each violation by date.
<br />t l.:. "no dischn'~e" occurs during monitoring period; ent 7 "No Disd~argc" acrusi fora is plrce of~a~a entry.
<br />12. ':n~er 'S~,',r,»~/r"i!.'. ~,/' t=r6rciF,1! F.x=.ar'ir_ !~~a-" with "Sid »1lur~ rj f rir•:-i1 rr Er. _-trtive G~~ ~;• ~,f - r~da :, izzl
<br />~;g_nr,""Te!_rlrone Numbs.-,"and "Ca(a" at bottom of form.
<br />13. ;~dail signed Repot' to O~ace(s) by date{s) specifiul in permit. Retain copy for your records.
<br />14. More detailed wstructions far use of this Cis.h~tg~ Nori!~rieg k=pea (/%iY1FeJ form may be obtained rrrom OTx(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is regtured by law (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 510,000 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 />EPA Form 3320-1 fRev. 03/99)
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