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1_L~~ 4J ~.. V~~U.7~J:~\ 1.®~ii ~'~..a~.L lyli~L'1 ~Fi.li. 1'~T l.i ~:..~Ji
<br />?uhlic reporting burden for this collection o.' nformation is estimated to vary from r. range of ] 0 hot:rs 2s an
<br />average per response for some minor faciL't es, t~ 110 haws as an average ge- rsponse fc- sc~..~ m~ or
<br />facilities, with a weighted average for major zvJ tr i ~.cr facilities of 181 ours pe= res*.onse, int: a iutg :=_ne `or
<br />reviewing instructions, searching existing :,ita s~.rrces, gathering and naintairr~ g the dz3 n~~~ed, r.id
<br />completing aed reviewing the collection of n:o.-naiion, including st_ggestion :or -educing this burc;en. to
<br />^hieF, Information Policy Branch, Pik-223; U.S. ?nviromnenta] Protection Agen;y, ~iOI i•+: S's~et; S.'Ai.
<br />Elrashington, D~ 20460; and to the :Jffce V.' . ~,%ornztion z td Regulatory A~'~irs, ~_ fee of i:Qa - a emc_tt and
<br />3udget, Washington, DC 20503.
<br />
<br />1. If form has been partially completed by pr, : aria„ disregard irstrucricn O.-cared at cr'ry of tha` in:~cr.na~ion already
<br />preprinted.
<br />2. 'rater "Per;;.ittee Narte/Mot!ir,S fddress (a'. ~ iacilily nameAecztion, if d+'±Tcrent)," " Pe.;ait Nurt~e.; and ",,^.is,:;tart z
<br />Nun, bsr" where indicated. (A separate fo.,n : , requ rec. for each discharge.)
<br />3. Enter dates beginning and editing '7Yo:,itc: i, ,: Perirxf" covered'oy form ~:+hr-c indicatrd.
<br />4. 3ntcr each "Parameter" as s_~ccified in mon= .,ring requirements of permit.
<br />5. ?nter "Sanple i.:ensurer.tent" data for arch t uametcr un•_'cr "~+rsatiry"anc (iuati!y". , s;.ecified in c~.:.:~t. ;' xr ga" s
<br />normally aithmetic average (gennetr;c ave .,e for bccrcrial :a,a~-.eters) o't tl sample n -asurenrer"s 'r eaca ,• r:nee::
<br />obl.:ined during "Monitoring Period"; "I•Ao.,,,a!m" ~~id !/.i,~%rrm;t" aze no-•~.Ily execs: high a-d'~~^t m_ sur:nens
<br />obtained d~lrino ".'vlaaitoring Period". (iQcu: tc rani vitals with secondary t•:~mlent reef lament: °_nt a 3:1-<<y a~ era^:
<br />of sample measurements under "Ave:•,~Se," c -d :^t.r naximum 7-day ave: age of sa't21~ measure^en s a bi ud Luri,~
<br />monitoring period tinder "Maximum.")
<br />b. Enter "Pandit Requires, ant":or eac:r patam- ::r tml~:r "Quantity" and "~irralirv" as sperH .d in pern a.
<br />7. Under "No Ex" enter n•.rmber of sample mc, surcmcnt during monitoring period its[ ;.~cc_;d maxim~~m (ai~o • :~i• inrr.
<br />or 7-day average as appropriate) parch req•~i-emen~ for each parameter. if Done, enter "0 .
<br />g. Enter "Frequency ojAnalysir" both as "Sa. ;ale 1/,zosureme7l" (zctual freque.~cy o~ :ar. piing and anrlysis t scd iurirg
<br />monitoring period) and as "Petrtit Requires, ~;rt"specified in permit. (e.g. Enter "Coca, "f r con;inuo~~~ ncai:cru E. "//7"
<br />`or one day per week, "//30"for one day pe mont>>, "//90" for one day per quzre-, etc.)
<br />9. Enter "Sample Type" both as "Sanple Meas•~reme;:r' (actual saSnple type used dw-ing me ~itoring Feric ~) and zs "; en;,:i
<br />Requirement," (e.g. Enter "Grab" for individual sample, "24HC" for 24-!lour coc nosite, 'nt/i'' for coy:muous
<br />monitoring, etcJ
<br />1C. ~'/here violarions of permit;equirements az.; reported, attach z brief expla7at;on to dcser;be cause and come:,-ive actic~s
<br />to be taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, cater "No Discharge" across form in p'xce ofda~ entry.
<br />12. Enter '7Vame/fitle of Principal Executive Cff:a " vrith "Signature g` Principal E: ecutive O~c•er oj' Aut;torizea
<br />Agent, ""Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) sxcified in permit. Retain copy for yc~ re: c. 9s.
<br />14. Mon; detailed instructions for use of this ^ischo.ge Monitoring Report (Dk9~ fo~:zn rtay be obtained from Office(s)
<br />specified in permit.
<br />~c~al I'~Toticc
<br />This report is required by law (33 U.S.C. 13l t3; 40 C.F.R. 125.27). Faihue to report o; fa! i.ue to report tn.[ [fully can rsult in
<br />civil penalties not to exceed $10,000 per day o'violation; or in criminal penalties not to r.:ce;d $25,000 :er day of vi_laton,
<br />or by imprisonment for not more than one year, cr both.
<br />E'PA Form 3320-i (Ed¢v. 03/99)
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