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Paperwork Reduction Act 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 hours 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 Information 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 drrected at entry of that information already
<br />preprinted.
<br />2. Enter "Pennittee Name/,'l4oiling Address (and facility Dame/location, if different)," " Pannit Number," and "Discharge
<br />Nrrmher" where indicated. (A sepazate form is required for each dischazge.)
<br />3. Enter dates beginning a7d editing "Moritoring Pe; inJ" covered by form where indicated.
<br />4. Enter each 'Paraiazter" as specified in monitoring requirements of permit.
<br />5. 6nte; "S1,;rFle rLL~.rv; z+;n_irt"data for cacti parameter under "~uantiN" and Qrral~n+" as specified `n permit. 'it ver~~e" is
<br />normally arilhmeiic .r^ra~c (geomctic average i'or hac'.crisl psra,ncters) of all saml,le measure ncns nor each per: ncLr
<br />obtained dur._g ";v;s„i;~.ring FGri•,d'; ",11~ri+an;n" a;7d A4i:ri+n;mr" a-e no-orally cxir_.ne I7i;;h and ~o•:+ meascr^_mcns
<br />obtained d~nv7g "i•hruh,.iae PsrL ±". (`:otc to mua'ci~als s:i~7 secondary :reaun_nt ..su:rcmeat: ~~b.r 3C-d-y e'+c-ugc
<br />OI sa mtTlC m:rSW-CiTGli9 L'ud!'r ', ... cad C-tCr u~~~.(SGll rP 7-dcy Lr C~agC Of5<<"T~'~ tC mens nrGT. evils OJiLlnCli deln~
<br />ma-itoring period under "~!d~cimarr.") .,
<br />J. .-~ei"~"Gli9!~G~~1!1,1n.Gi!""Ur CGeh t7ail-'aCl i~'~_7"_i'~L!1/)~°i~3~"~!Y_11/:J~n255r2Cf11~•G i0 i:C7]]'t.
<br />7. U ider ". :'~, S,r" en7 n(,n~er uCc:: -. ,le nr~sureTC ~+ uu~~ng ~-o.li uri.i" ,_-;sc: .~ a? :::cxd maxi num (:nd/cr ~ti 'mis^
<br />or 7-lay ave~r~e as epp upr:aic; ~ ±ii rcqu'nmc~,t "ur cash pa;an7azr.u:Cnone, enter "('"
<br />~. °o'~- "!•7~.1r.•,r_~ ,tn.lps'," t-'n ,s "S_, : la n:G~~t~rsm_m" (aci-~1 ~ equc: c, c'sampring •~ (f cri~lysis :~sc6 , y-.,;;
<br />moriicd~;; period) a . as ", _~.,,i! R: ~r, e.i ~„'"spec;~icd in pe~m~t. (u.g. ':n~cr' : +i ".or con('n,.oos muni:o,Zng, "//7„
<br />io* one d£/ per vrrcl;, "+/30" for one rl:ry ;,e,-month, "1/70" for occ day per gw•tr~..:;, cic )
<br />9. ~n:er ".S?+I rFh T)~•.. ' ilU ti7 ,.,. "SJ,r"r 1G iu,'; ~i'. _ ,._r.+" (YCil-1 g-mn1C iyl:C L'SCd dun ag ~ ~ ~ ') "? •,-„ril
<br />TUn1iJ-.L. 7L'10~ £n. aS
<br />JiGyeir~„real," (cg. '~ntu; ":,raF" fcr ind;vidual sample, "?4lrU" for 24-Four composite, "i~'/a" for cor.'luous
<br />monitoring, etc.)
<br />' 0. !'/here violatio;7s of peirnit requircme..ts : re ;: of~ed, at~ach a bneC e::planatica to d_;cribe caesa and cuncciive ac;io~,
<br />[o be taken, and reference each violation by sate.
<br />l I. IC"oo discl7erg," ocru., d`rin;, moi itc~ing pcricd, a 7'.cr "1<'o Discharge" across form n place of data cnt,y.
<br />l2. Enter "T+s,:ra~TitL• of F+-i,7,:if al Lxr,:utiv ~ Offr; er" with "Sigrrahu-s of Pri+r ~iF~! ESe vtive O~~er of Aeuheriz~ 1
<br />Agent, ""Teleplrns Ne,:+l'a ; "and "Gana" at bottom of form.
<br />13. Mail signed Repo+i to C~ ce(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring 2port (D,t9R) 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 result in
<br />civil penalties oo[ to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment for not more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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