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~ Paperwork Reduction Act Notice
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<br />' Puhlie retx,ning iutnirn far lilies culiecliuu of wfc,~: ~., ~.,.w '. ~~-ai:,:_::.:.' (., very f:,,:u ~ ranee of i6 huun a, an
<br />average per response for some minor facilities, [0 110 hours rs an average per response for some ma3or facdines,
<br />with a weigh[eu average for ma3or and minor facilities of ! 8 hours per response, mctuding time for revrewmg
<br />instructions, swrching eaisling data sources, galherin,2 and maintaining Lhe dales neuled, and completing anJ
<br />reviewine the collechon of informa4on. Send comments reeardin¢ the burden estimate or any o[har asnut of
<br />• this collection of lnfnrm!tinn, including .cuooectinnc for reducinv this hurdrn, to Ch!~f, lnfn~_atinp pnliry
<br />Branch, PM-223, U.S. Env/ronmental Protection Agency, v01 M Street, SW Wrshington, UC 20460; and to the
<br />Office of Information and Regulatory Affairs, Oltice of Management enJ Budget, Washington, DC 20503.
<br />General Instructions
<br />!. If form h been partially rnmpleted by nrrnrinlino, disregard inctruMinns dirrrted at rntry of that information
<br />alrrady preprinted.
<br />2. Enter "Permittee Narne:afailing Address (and facili[}• name/location, it different)," "Permit A'unrber," and
<br />"Discharge Number" where indicated. (A separate form is required fur each thscharge.) -
<br />3. Cntcr dates bcgmmng and ending ",tlwuturull; Perrud" cocercd by fotm trherc indicated.
<br />a. Emcr earn °rnrnnirrrr' ns specified .n monitoring regwrements of pcrnut
<br />5. Enter ".Sampi; ,lleu..u,~-•ureln" data for ^_ac!-: parameter under "QunntiR" and "(7unlity" in units specified m p:.rntit.
<br />".a veroge" is norncdh anthmdic average (geometric a~crage for bacterial parameters) of all simple measurements
<br />.~,unitru~u r~ Pu~iu, .'.: m~vaulr," and ",l finunum" arc nc: all;• -:.'. remc high
<br />for caeb parunder obtained during .:,' n P' .
<br />and low mcnsurcmcnts obtained during ".l/aumru_, !'r~iud" (Note to mtuticipals with scconGar}• treaunem
<br />rcywr.:nicrii. F:uici ~::-J.:-, a•.u,/d.. ;, s.,+op'c .,...~-•..,~:-.in's .' r-- "..1:;~„gee" and .°nter ma>_~mtur'-day a•:eragc
<br />of sample mcasweutenls obtained during monitoring pcrior: •.nc:c ".li2:ir,„tun. "7
<br />fi En!cr "Prru!N ken, nirnmenr" for each pammelcr nrdc: "Uunnfiry` uau "47anbly" s spcctficd :a porlml.
<br />;. Und.r "^:n F'x" cct~: .^....r.L•e: of sample mcasunrc^!s rinrinb mnnirnnne nc~p: that c,cccd maximum (and/or
<br />numnuuu ui ;-des. Hv,.ingc ;~~ app~upr,.n..i p..;:.;, .,..~,.;,.::-,_:.; ~: cac`, p;.r-.:: '..rr.c ~.:. _,.... "^".
<br />C. EnICI "i'n'qu:•n~v ,J ., nlii N3"~ pJtli •• iA~.: ..,_GS 1,T:. t~ ..Lye-... Uj rL:"o' _ _ ~ltiii'. - .. ...u
<br />during monnnring period) and as "Prrmi( kegmr:uu•nl" spcrifiCtl iu pcrntii. (e.g, L~dc "('.,nt," For continuous
<br />~r,u„C Oreg. "! 7" ::..- ere j.:•: per ~,c::Ft. ,.l .~,. ,~,.:.., ..~ ,. ,,. ~-,,~.••h '• r -9h" f.,- r, r.- ., . _..r auaricr. etc 1
<br />U. F.nler ".~•n/Ilpl,' lip:' nnlh as lnlnPn' 1/l ll.eilrPltl t911 t,LL:n,~i D.IIUUiC /, N~ ~~w u ,up, ,u~i, Gl.,~bg Nei ..,.:~ ,.-. ~~
<br />"PI•rmit kequirvrncnt," (cg, F.nter 'Groh" for indit/duni sam0!c. "?al/C°' (or ?a-hour composite, "`.~ I"Jlor
<br />widinuous monitoring, ac.7
<br />10. Where violations of pernlit rcgwremcnts are reported, attach a brief ezplanaiion to describe cause and cmrcctive
<br />actions taken, and reference each violation by date.
<br />11. if "no discharge" occurs during monitoring period, enter "A'o Discharge" across form in place of data entry.
<br />12. Enter "Name/Ti(le ojPrincipal Executive Officer" with ".Signature ojPrincipnl F~xeculive Officer ojAurhorized
<br />Agen(," "Telephone Number," and "Dore" al bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afoniroring Report (DtifR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties pot to exceed $10,000 per day of violation; or in crirttinal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for pot more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
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