|
Paperwork Reduction Act Notice
<br />Public reporting btuden 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 l8 hours per response, including time for
<br />reviewing instructions, seazching 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 />]. If form has been partially completed by preprinting, disregard instruction duected at entry of that information already
<br />preprinted.
<br />2. Enter "Permirree Name/Mailing Address (and facility name/location, if different)," " Pernri( Nunrher," and "DisaSarge
<br />Nuurter' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period'.' covered by form where indicated.
<br />4. Enter each "PQYamdldY" as specified in monitoring requirements of permit.
<br />5. Enter "SwnFlz ,Lk~su:z.:rznt" data for each par meter under "~nrarlri!J~"and Qu~(ih,~"as specified in permit. "Avzroaz" is
<br />acrnalty aritl,met;c aterage (geometic overage for bacterial pr metes) of all sample ncasurencn's for each pr_~meLr
<br />obt.rinsd dt~ii-g ",Lis..i!uring /'mod'; ";/il..ium:a" and /vTiui,,;am" a-e normally _:ar. ~c high and ]ow measwutnnis
<br />obtained during ",'.':uir~.ri:rg Pzrioi". (\ole to mu-cipals ~ri;h secordra, trcatn:~~ r._ ruiremen[: Fn~cr 30-day avc age
<br />ofs:.r-~p+e mcur-emcnts order '~tv~rs~,"a:d ent~T -*rxirum 7-dey cv~ ago ofs.. -; fe mcasu-:n-_nt, o':<rned du ic~g
<br />mo t i to ring period [order "~riaximun. ")
<br />u. °_rtc, "?s~.,ri! R.•,~r',.m';;I"for cac'. parnmrtcr ~m~::,- "~r,,,r;i/, .~~~ "~v,_,ii1•,,'a, ~; rci ic~l in penn't.
<br />7. lind~_r .'.. , ~~r" .. _. m.ra'.:;- of sample mcasurn,enl dcri,rf, ~~on~t~~i i~ ..;mad t~,.,.' ,._ _,c: n~:~~imu~n (muJnr mi: •nwr?
<br />Oi 7-d_y aVfrr~J as y: prO~~RBte) 1:Cr~m i1 sqc li L:neni Ui each pw::n-etc r. ii i~OL :, f liCi "~"
<br />8. 'n'e- "Fr=~ ~_n ;, ,y',i:, ,l;•s%~"both as "S •., -'° i+f. ~,~~,~~„r'ur" (acfuzl f _ _ ~ c; r" sa~~ ding c-,:i an: lyxis used uvhig
<br />In071iL_"1~ i7L'P.Od) L . ~ ci "1%_': 6?i! /i_'?LliG.71.~~ " s sec; fed in perm!. (e.g. 3nt..: "~ vd'. " iCC ce.]ilnuoLS :nav:oRrg, °I/7'r
<br />f..- one day per s:ec:c, "!/30" far um: day r.cr month, "1/90" for one day per qu~~tcr, c~c.;
<br />9. Cn'er "S~rr; !, Tyr" Solt as ".S_~,nrl. dG .~sr•.•s,na;r~" (~cu~al sample t:,~}tc cscc' dori tg :r~nito-:c;; pa.icd) anL as "Ps,;;ri!
<br />I~yr-~ir~rr~.r'," ;e.g. Eater "Gr_~h" for inctividrial sample, "14;1;:" for Zd-boor r,:.nposite, "~1r/f"" Cor coniiaunos
<br />monitoring, etc.)
<br />10. F/hcre viol2tions of pc~nit requirements are reported, attach r. brie:` ezp+cna+.i:n to d_se, ~bc case and cureclive actions
<br />to be ta:ceu, and reference each vio]ation by date.
<br />1 ]. Ii "no discharge" ncctus during mon;toringper~od, enter'^do Cischarg=" across fo~;r in nl~cr, o:'d:a:. entry.
<br />12. Eu'.er "Name/Ti!k of PrAm•il-al Fxso-utivz GfJi,:_r" with "Srbnlhr.~ ojl,in_if_~! Fcc_rr!iv~ G~_'zr oj,.u~lr~.ri_ud
<br />.4gznt, ""Tzlzplronz Nu,nhzr,"and "Dale"at bottom of form.
<br />13. Mail signed Repot to OfFce(s) by date(s) specified in permit. Retain copy for your rcco.-cs.
<br />14. More detailed instructions for use of this Dischlrge M.ui!~ring R.aFor! (D:191i) form may L.: ob[aine3 from O!'ice(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 not 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 year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
<br />
|