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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, seazchirag 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, disregazd instruction duected at entry of ;hat information already
<br />preprinted.
<br />2. En[er "P2rnriltaz Name/Mailing Address (and facility name/location, if different)," "Permit Number," and "Discharge
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Mrnitoring Prrird"covered by form where indicated.
<br />4. Enter each "Porameler" as specified in monitoring requirements of permit.
<br />5. Enter "S-r+npld lvharur~+aenf"data for each parameter under "~uanrity"and Qera[i~'" as specified in perrut. "Avrragr" is
<br />^crmaL'y arithmetic avcrge (geomcnic average for bacterial parameters) of all s, mpic measurements for each parameter
<br />obtzined dur`~g "SP•ni!oring Pr;iod'; '7Nazin, em" znd Atininnnn" arc normally extreme big and low measurc~nemis
<br />obtained during "A.';aitsring Pe+i•.1". (A?ote to municipals v:irh secondary treatment requirement: °_ntcr 30-day a•:ers,;c
<br />of szn-~plL nrccsurcmcnts urdcr "~:v~raga,"and enter ma;:imum 7-dz}' avt-ago of s:-iple measurements obtained d~r,ng
<br />monitoring period under ";vlaximrum.")
<br />u. Lnt~r "Pzr,.:i~ P~?ui.•.u+art" for eac5 parameter under "Qumuity" 2nd "ihrality" zs spcci;ted in pcztit.
<br />7. Ur.' •. ,. ,.. " e-:cr numScr of simple me;.serrne~Y during monitoring pcrod first eteccd maximum (end"or mini:n~.~n
<br />cr i- :'y zvc ~gc ,~ r faro/,riztc) per;nit requi-emcnt for each parameter if none, cnt~r "7".
<br />II. '%nt.:r "f,: ~1",._~' L~~i; ii_'l~'CiP" 60th n "S:]UiF/' lU -KIU 'ids;: " (actual frCaL:.RCy Of FaTni;l1II,^~ il]d arl QlySlS LL50d dCT7n~
<br />m pnlt0~ng 11~Od) a ; ~ Gti "rc,l;i rt R~7uiraat;r/"specified in pc~nit. (c.g. °_nter "^r,,;i,"fcr ccn_tnuous monitoring, "//7"
<br />`or nnc dry p..r wed;, "//?0" for one day per month, "1/90" for one day per quarto, etc)
<br />S. inter "S:,r,lJ~ T;y ~"Seth zs "Sai,~~k IA_ssnr r.;n rnt" (actual sample typo used during monitoring pericd) and as "Pa~,+i'
<br />/L.,~ui,ear=at," (e.g. Sntcr "Gr_/" for individual sample, "24/f:'" for 24-hour co:uposite, %''/A" for contnuous
<br />monitoring, etc.)
<br />r 0. 1'!'•cre r~otr.ticn; r.f pcTit requirements m~ reported, attach a bicf e;;planation to descn'~c cause and ce-rcc:ive ac5ons
<br />to be taken, and reference each violation by date.
<br />11. 'f "no discha-gc" occ:r ~ during mor.'ICrin^ pc;icd, enter "\o D scharoc" across fern in place ofdrta carry.
<br />72.n[cr "Narre/Ti1!_~ ~~" ":inrirll F,.~-raNir~ ~ffia~. ' n^Ih ".Sisna!rrr~ of Pri+r.dr.,( lira~,r!ity G~x~ ~•f Ater`-riaeJ
<br />,Sg~+tt, ""Teleoho,te Na'sihzr, "and "Data" at bottom of farm.
<br />' 3. Ylail signed P.c, ort M Office(s) by date(s) specified in permit. Retain copy for your record;.
<br />14. More detailed instruct~ans for use of this f%i:,:hargt M,nita-ing R.apo+4 (Dtb,7i~ fo~,n may b, o'~ta`ned from Offices)
<br />specified in permit.
<br />This repod is required by law (33 U.S.C. 1318; 40 C.F.R 125.27). Failure to report or failure to rc; ort truthfully can result in
<br />civil penalties not to exceed $10,000 per day of violation; or in crimina] penalties not [o exceed 525,000 per day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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