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<br />Public repot2irtg burden for this collection o': info.mation is estimated to vary from a range of ]0 hct-s as an
<br />avenge per response for some minor facilities, to 110 hours as an average per response fo- soc~ a _jor
<br />facilities, witL a weighed average for ~ajos- aid Honor facilities of 18 hours po: reapouse, inci.t_ing'..`me for
<br />rev_ewing instructions, seazching existing <ta so.:rces, ga[;iering aic; maintain'ng the ~~ti. nec9~d, rnd
<br />completing and reviewing the collection c''_~fc;oration, including sng~estion for reducing £ti~ "o_rde;t, ~~
<br />hie*, infotmation ?'olicy Lranch, ; V-223; 'J.S. Envirorunen'uil ProLPction t~gerlcy, k0: i!!: Ssec; ~.'J~.t.
<br />~'tashington, T`~ 20',60; and to the C~ce o_`~f'o-rnation and Regulatory ~ffzu.',, ~:nce ofi!-i-nrge_-en: ~u
<br />Budgei, V/ashington, DC 20503.
<br />
<br />_. If form has been partially completed '?y pr, minting, disregard iostructie.l directed . t e -try of Tret i~fr rmaCcn :+readt•
<br />preprinted.
<br />2. Eater "Pernittee Arame/tY.a;ling r!3aress (t •:] facility name location, if difarent)," " ; :nit Nw.~- ~. " r_nc: "i,!: ~.4orb;
<br />Numrer" ^~here indicated. (P. separste fez; s required for each discharge.;
<br />3. Enter dates beginning and editing "ivlonix; %, ;Period" covered by form v.'be-z indica cd
<br />4. inter each 'Po; arrteter" as specified in mor wring requirements of permit.
<br />5. Enter "Sar,:ple ,:~sosereneut"data for r.;.Vb irame;er under "Quantity"and ~h'alit~" is . n;;cii ied ;'z ^. ~r.:. "-ive.•~: ge^':
<br />normally rrithmeuc avernge (geotneL-ic av::;;c for U^aerial parameters) r.Fal] ;ample ., czs!semc~ts :or cacti pr -.me:~
<br />obtaRell dllgil„a, "ivionJlO!(rig i e:iOd"; ";.1 _6:, L9:1" an4 IVILIi .twit" rSe nOT,atl,/ C` . ii 1.9 ]]lg<7 aLd ~~P/ O'CaSll'i.IlEil.,
<br />obtained d~~-ine "ivlo:rtori;rb Pe:i. {". (1~AlJ CQ mL'11C1paI5 \'RtI] SCCOndary tC2dtaiCCt rf'.1LLII0mf1t: ~. Ei :'~-: a~ .b~I~o,
<br />of sammle u~easurements under 'Ave;_ge,"rid emtc; m;~:cim~!ro 7-day avna~e ofsan~lc measur. r~-a otG:ret csr_~,
<br />monitoring period under "Ivlexirlum.")
<br />6. Enter "Pc»-.1it Regufrerleat"for each param_~er under "Oaan!ity"a.nd "Qrtatity"zs s:-cif cd in pc<'rit.
<br />7. Under "IJo Er" ente. number of sample me-~,~emcet Luring monitoring period the: ~::c-cd maxiru. ,- (ands • ar~r1.
<br />or 7-day average as appropriate) permit zenu' •cmcn[ iar each paratnetcr. If none, enter "P '.
<br />8. Enter "Frequency ojAnalysis" both as "Sa ,rple Ivieasureme:rt" (actual fregrer,cy o` sa*noliag any: ~alyris used d~?riro
<br />monitoring period) and as "Perr,Ji! Rege%rer c.Jt" specified in permit. (e.g. ~-:er "Cc..!," for continuous moniierin;;, 'li7"
<br />for one day per wee'.c, "1/30" for one day per ~ontb, "1/90" for one day per quarter, e' ~J
<br />9. Enter "Sample Type" both as "Saraple ttieasurement" (actual samp]e type used durinL :*~nitorirg ~ercd) and xs ' °er,.l%!
<br />Requirement," (e.g. Enter "Grab" for individual sample, "14HC" foe 24-horn composite, ''i?'/.1" fo. continucus
<br />monitoring, etc.)
<br />:0. Where violations of peznit requirements aze reported, attach a brief explanation to desc.ib= cause ~ d corrective acticn.;
<br />to betaken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Bischazge" across form n p Izce of data entej.
<br />12. Enter "Namell'itle of Principal Executive Officer'' with "Signature of Princ%pz! Executive O,~%cer of A1~tiorized
<br />Agent, ""Telepho,le Number, "and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) s zecified in permir. Retain copy for your r_cords.
<br />14. More detailed instructions for use of this Ciscllorge IvPoniforing Report (DMF~ form may be obtained from C~cc(s;
<br />specified in permit
<br />,~~~~1~ ~1®~~~~
<br />This report is required by law (33 U.S.C. 1318; ~,0 C.F.R. 125.27). Failure to report or fai:ure to report =_ stully c.m rsult c
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 cer day c vialation,
<br />ar by imprisonment for not more than one year, o_ both.
<br />EPA Form 3320-1 (Elev. 03/99)
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