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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 t~cilities 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 directed at entry of that information already <br />preprinted. <br />2. Enter "P,arndttza Name/hf~ifing Adlress (and facility namc.rlocation, if different)," "Fannin Numh_r," and "DLc~h~rss <br />Number" where indicated. (A separate form is required for each discharge.) <br />3. F.ntcr dates beginning and editing 'Stk»it~.rins Period" covered by form where indicated. <br />4. Enter each "FJI'lm.'t2r° as specified in monitoring requirements of permit. <br />5. Enter ".S un11_• Alncur~»crrt"data for each paramaer under "-,»snritt".Ind duality" as specified in permit. ".Iv ;'. r,, '" is <br />normally arithm_tic ac'zraez (geometric avera ~c for ba~;.r.ll parame[en~ of all sample measurements for each para~n,rer <br />obtained during "A1 »ir,ri»y F ri;d'; "Marinuurr" and , '-• ~r.urm" a : nrrntally extreme high and low mcasurclm n•r, <br />obtained during "11,»ir.r~ius F~riod". (Alote t,: municipal. •,. i;h >rc,:,.:'.,ry treatment rcyuircn>•:nt Enter 30-da}' av; r,~ ~. <br />of sample measurement. Cnlier ",4G'r7y_ ° ^il~i :rater maKIIllLln; . J'~~, ,.~rrage of sample measurcmrn;, oh!~inrJ dlu;"~ <br />moniL~ring period under "d11ri»rrun.") <br />6 ~.race''l';ant[/i.•-lnir_m_t;1"'~rz.uhpwur;eA:render"~rur,:,'tr"..-_'.u~lity"asspccificdinpcnnit. <br />,. l'ndrr "r<'. C.r" en!cr nm~rhzr of sample mzasw.•mcn[ Burin ~ :~, ,;~ ariod [hat exceed muximwn (and"~ r n i:~iin!un <br />cr 7-d } :IV~'a~e a., appr~~,f,riatc) permit n•,~uir.'„tcnt for e~cl:~ i~:u;vrz'.. ~~ ~' Fnone, enter "0" <br />8 Grater "Fr.~ pr.rn p , (.1,r_rh ci.c" both as "SJOI~ .' tL~~.~urrr,: ;r[" (act _~;uzncy of sampling and anal}>is Ic:cd d:,riug <br />ntonilnrn, pcriodl and as "P~l'»llt R_./uiram_art"spccifeJ i~! ncnr!~~ r,. toter "Cent,"forcontinuaus monitorir. ~, "1~"' <br />fi:r one day per neck, " ;311" for one day per month, "1190" for on.. d.rv n _r quarter, etc.) <br />~. Prater ".Smq l ~ Try •"both as "S~nry-[~ 61rr,zcur ore, ir[" (xh~al •,:Implc ~_ I•. u;ed during monitoring period) and ac "F ~r»rit <br />l:•.:yuiram.•rt[," (c.g. Prater "Drat" for individual sample. "'aH "' for 24-hour composite, "N~A" fix continumrs <br />monitoring, etc.) <br />10. ~'r'ltere violations of permit reyuirements arc rrnortcd; attach a brief z:q-~!anation to describe cause and corrective actions <br />to be taken, and reference each violation by date. <br />I I. If"no discharge" occurs during monitoring period, enter "No Discharge" across folnl in place ufdata entry. <br />13. Bnur ".n(lm_-/TttL . J Frf»ciyal Eze,:utivz C~~~r" with "Sisnahu ~ J Pri,r'iy.J F:rzautirz Gear rf .4»[ln.r'i_tl <br />Aea»t, ""T_~1~Pho»s Nu»rb_ r, "and "Date" at bottom of form. <br />13. h1ail signed Report to Office(s) by date(s) specified in pzmtit. Retain copy for your rocords. <br />14. More detailed instructions for use of this Die ~h~rea A1,ni[-w7ny R_1 ,rt (I ;1!FI funn may he 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 ~7). Failure to report or failure to report truthfully can result in <br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not [o exceed $25,000 per day of violation, <br />or by imprisonment for not more Utah one year, or both. <br />EPA Form 3320-1 (Rev. 03/99) <br />