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<br />hblic reporting burden for this collection of information is estimated to vary from a range of ] 0 ho: a r r: an
<br />average per response for some minor fae~Lties, to 110 hours as an outrage ter resporse i~- scce majo-
<br />facilities, with a weighted average for major zed rsinor facilities of 1S bouts per response, including :mc fo_
<br />re'i.etving instnctions, starching existing iota sources, gaC~ering a?d maintaining the data L:Encd, ~d
<br />cotn;~leting and reviewing the collection c` 3forrtation, including suggestion for reducing 'his bt°•de ~, to
<br />~uief, Information Policy B_anch, FdI-323, J.3. Envconmental Protection F.gency, k0 iv.: ~ie~', i;.W.
<br />F'ta~;ungton, I;C 20460; and to tht; Cf ice c,"L.i,`an~~rioa and Regulato_y ilffairs, Cice of ivl" tag:,.-cnt =nd
<br />budget, Washington, DC 20503.
<br />
<br />-. If for.'n hzs been partially comple[ed by p,z7ntine, disregard instruc5ca directed rt e.i5y of that r~fermation clrez;
<br />preprinted.
<br />2. Enter "Pe; ~aittee Name/Mailing f?dd: ess (znd facility name~ocr.tion, if diP'crcot)," " I'„sir Nui.tl. ~ ;' rnd "Di; theta e
<br />),-'umber" tvhare indicated. (~. separate feti'1 's required for cacl discharge.)
<br />3. ~nx; dates begim~ing and editing "i~r;;itori..; Perim" covered by fo:m whoa indicated.
<br />'l. Enter each "; ara;neter" as specified in mot ta-ing requirements of Permit.
<br />5. Enter "Sample ivleasure,ne.a" data for each _ ~ ~stmetcr under "Qua,:i%ty" zn3 O: ~slity" zs sp~cifcd ; .t _: ~nri~. ",'vs.• age".,
<br />no,mally Eilt`rnetlr. ave.age (geometric :.vc..,;c for b_nterial pz :.miters) of zl! samples _rswemenm ~e~ ea> >. p~ une:e:
<br />obtained duri.tg "~iionirori;rg Period; ",vim L:rt!ia" ana r/li,rinnm" are acr~c',ly e: `c, 'e high and cei n..asu rmeis
<br />obtained during "nlonitoringPe:icd". (~Iot: io musk:psis with eccondar,~ teaate,^.t re: ~irement: 5 r. 30-iay _vera~.
<br />of sample measurements under "Anarage," • tr. ,;ter ma~cimam 7-day ave2ge of sarn~!~ measen:7c h; ob'zina curl o
<br />monitoring period mtder "iviosimum. ")
<br />6. Enter 'PdTWril P,eyuiremerr"for each prrameter ands "~@an71y":.nd "Qualrty" as arc;. i :d m pe.nrt.
<br />~. Under "No Fr" eater number of sample mersaremun: du.-ing monitoring eriod that a :e_ed ma;:iru - i rrdlc: ni:imwn
<br />or 7-dzy average as appropriate) perct req_~ •.~teit =or each pacumeter. If none, en~,r "0'.
<br />8. Enter "Frequenc7~ ojAnalysis" both as "So..,ple ;~:e: su;•e;,rent" (actual Gequency cf sar.~liag and :',lysis ~ seu curicg
<br />monitoring period) and as "Permit Regrrz,zrieat"specified in peanit. (e.g. Enter "Ccrt," c. contim.o:L, mon t~;,-h,;, "1/7"
<br />for one day per week, "1/30" for one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter "Sa+nple Type" both as "Sample Mea~.~remerrl" (scion] sample type used during m~>itoring ne 'rd) and as ' 'en.t%'
<br />Requirement," (e.g. Enter "Grab" for individual sample, "24HC" for 2k-hour composite, '7t~~~~" "or cont:nucu:
<br />monitoring, etcJ
<br />10. V/here viclatious of permit requirements ar~ rporied, attach a brief exp]anation to dJscibe cause a ` co -receive r.cticaa
<br />to he taken, end reference each violation by ate.
<br />11. If "no discharge" occurs during monitoring period, enter'tZro Discharge" across form .a place of dam ~ try.
<br />12. Enter "Nan, elfitle of Principal Executive ~cer" tenth "Signature aj Print%pa; Executive Oy~cE~~ oj` Aut.:oriz°c
<br />Agent, ""Telephone Number," end "Date"at bottom of form.
<br />13. Mail signed Report to dffice(s) by date(s) specified in permit. Retain copy for your cco: ds.
<br />lk, Mon; detailed instructions for use of this Lircharge Monitoring Report (DPAl~ fc~n nay be obtac.ed from C;fice;s)
<br />spec:Sed io permit.
<br />_~~~~:~ 1°~otice
<br />This repoR is :equired by law (33 U.S.C. 1318; ~; 0 C.RR. 125.27). Frilurc to report or fai.ure to roport re ~: billy can rsult i~
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to c.ca,xi $25,009 ccr day c `violatica,
<br />or by imprisonment for not more than one year, o; both.
<br />~3A Form 3320-1 (Elev. 03/49)
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