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?~~~erwork Re~~~~~~~~o~. pct Notice
<br />Public 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 110 Lours 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.W.
<br />Washington, DC 20460; and to the Office of Lrtfonnation 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 ducxtcd at entry of that information already
<br />preprinted.
<br />2. enter "Farmitlea Name/.Yfsilireg Address (and facility namrJlocation, if difTerent)," "Permit Number," and "Discharge
<br />Number" where indicated. (A separate form is required for each dschazge.)
<br />3. Lnter dates beginning and editing "ivionitoring Fern _/"covered by form where indicated.
<br />k. Enter each "ParJlne(er" as specified in monitoring requirements of permit.
<br />5. P.nicr "S~„rjle i.lasurzr;unt"data for each pa~nc?cr under "Q+urr!it} "and ~n.eliq•" as specified in permit. 'Awr.rb~"is
<br />nor natty a-ithmetic a~ erag~ (geometric zvcragc fur bactu-ial pa>Lmeters) of all sam~~le tne3surementy for each par : ~e~er
<br />oStained during "'~I.nir.riub Fa-iv1'; "iv,'_rriruurr" and /.ii,ri,,;.uu" are nonnaliy extreme high and low meaeurtmcnis
<br />obl.~ned d"ring ".; /' nir„in=' P_ri .+" rTdoic to municipals vrith sccon&ary trratmcr.t r yuiremem: r~te~ 3f.-day average
<br />nfsyr'p'e n-l,a•:c~encnh: tmdcr itv~r,rgt,"and c^?cr n~ar,imwn 7-::ay average ofszmple mesur~men~ obtained during
<br />monitoring period wider "iL/s-.imer;n.")
<br />G. G '~_. "F.:.,,ri! 2'; eir_rrrtni" °or each parameter und_r "~ir'lnlih,";_rd "~itralily" as specified in perrni
<br />7. L. LI,Cr ".J-~ 1:-" e-.I_- mm~~er Ui sample m.:csun.-ent during mcnitu! trig , er:ud ti~.Y c~eo.u nax~mom (r ~dlur mir~~oum
<br />ar 7-day tc~r ;;c as approp:isie) permit rcquirc.ucnt fur each paiantetcr. If Done, enter "0".
<br />C. %+l~_ "Fr;..m.a:n• r.i,r ~/rate" both as "S..•-, S: _•rurau_;rt" (actuzl Cr_q~oicy of sz nphr~ :.^d an.aysis used dur:n~
<br />.~amlc'rog pcro2l a'u: as'"f:'r,,,il R•;u'n ~nr ~r''" rpecifed in jrermii. (c.g. enter "~~,,a," Il'r eooti,uo:~s m.onitorirv, "7!7"
<br />i Vr Jilt dL~ 7d:' p,~ C~:, '/~~~" iUC OZC da)' a_: mUU~,li, "/!~0° iUr ORC day per gustier, CiC.)
<br />9. C:,'.. 'S:~;:;-(• ";y_ •' both as "C'„rr/~ ,;!'_vn smra" (actozl srmpl; qT_ ~cd during eani[orin~ period; esL as't'e;oni!
<br />Iv:/c~r:,ate+!." (.:.g. I~-~a: ":,r~l'" far individ~!~I swnp!c, "19H."' fcr 24-nonr comnosi[e, 'S1';.:" for cat?~n!~cvs
<br />monitoring, etc.)
<br />10. Cr~cro a~ol _tions uC;'crmit requrcmerrs me nporicd, atte_h ~ brief explana!~on to desc~he cause any cnrrxiive cc?icm
<br />to be talccry and reference each violation by date.
<br />I I. If"n~ tlisoLzrgc" ucet'rs dcring monitoring reriod, en~cr "?:o L`isef,'arge" across forr in place oCdala lmtry.
<br />13. ~n>.: "iJanrz/T.~!te of Trt,rcif~/ Eczadit~ GfJ::~r" with "Sid n.!ttu. '.f Frirt_i~.d lix~ ~r~iv~ G~i:~r r,J ifu!horized
<br />A,;,:nt, ""TeisFSr,n_ ,Vwnber,"and "G.rl~"at bottom of Form.
<br />13. ?flail signcci Report to Office(s) by date(s) speci5cd in permit. Retain copy for your records.
<br />iriorc detailed instructions for use oC this Gis_•harys ivl;nitorin~ 2Fort (G,'v.7~ form may be obtained &nm Office(s)
<br />sncci Pied in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. ] 318; 40 C.F.R. 125.27). Failure to report or failure to repoR truthfully can result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not [o exceed $25,000 per day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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