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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 roaintaining 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 />I. If form has been partially completed by preprinting, disregazd instruction duetted at entry of that information akeady
<br />preprinted.
<br />2. Ester "Pernrittee Name/Mailing Address (and facility name location, if different)," "Permit Num6er," and "Discharge
<br />Nrrmbrr" where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Paranretar" as specified in monitoring requirements ofpermit.
<br />5. Enter 'Sar,rpl2 Msosureman!" data for each parameter under "Y^.,n~nriry" and',7tra[ity" as specified in permit. 'Average" is
<br />normally arithmetic average (geometic av erage fo- bacterial parameters) of all srmple measurements For each parameter
<br />obtai red during ",V„nitnring Pa, isd'; ",bfzrira~ra" and l.fi~rim;nn" ara nor-nnlly extreme hig'i and low mcasurcmcnts
<br />obtained during "lA~,rit:.•i:rg ?ario,"'. (T~cte to rilunici; cs wiilr secondary trcatm:nt reauiren:eni: Enter 30-day svera;;e
<br />of s' nple mecsurements under "Av.:, og.~," rod corer ma;:imr-n 7-day av_rage of srmple measaremcnts obtained dvr,ng
<br />monitoring period under "Maxinrrm.")
<br />C. lin`.er "Perr,=it 2quiranent" ror cats parameter uad _. "~ea,vi/y"rod "~u.rlit)•" as specified in permit.
<br />7. Ur,le- "T.r~ F-" enter number of sample m_ts-~r.-: ;• d wing monitoring period thft :~.cecd maxirsrn (anti/ar minim:um
<br />cr 7-day average s ar, frcpriate) f,emi[ rcqui;ernert fcr cacl: parameter. If none, . ntn* "0"
<br />6. F.n[s "F,-a;r-.;,_y ~~','rr_~lysic" bolls ac "S ,. . ~-•;~; ,,.. '" ;rcnral ;emu-n,y of scmpling and am lysis used durinw,
<br />mo ii.o.ing pciad) and as "Fdrlirit R._./u;, ~r;r ~~~ ~" < <; S;:d in j~...uit. (a.g. rir,i:r "^~,nr,"For continuous monitoring, "//7"
<br />for ana day per wech, "//30"for one day per mnrt'i, "I/^0" for ore day per quarts, etc )
<br />~.'mlcr "S~rat:L• 7;rFa"baths "Sl+nrla ; -:~_ cr,~~,otr '" (r.~ua1 sampl.: tyn~ Lscj dur;n monitoring period) s.nd as "~zr~ait
<br />2~ui;arn_:rt," (e.~. 2nter "GraF" for ~adividr~-' ea;rplc, '7d//." for 2~'-hour composite, "Tl/A" for continuous
<br />monitoring, etc.)
<br />' 0. \`here viclations of permit requirements : ~e -c~.o~~?, rt.:. ch a b-ref r,:p'.aaation to c'escribe cause and corrective actions
<br />to be ta~en, and reference each violation by date.
<br />] ]. If "no discharge" occvs dur,ng mo~i°tor'nn po. god, en': -'Tlo Dischlrl;c" across farm in pace of data entry.
<br />12. Enter "NamJTitlz ,f I'rinctra( ~'_„rti~._ GJj%_c,~" ::ifa "Si~wrvrr oj!'r-4r_%p,;i F.x_rtan~~~ Offi_sr =•f Authr,;-iard
<br />Agent, ""Teleph ins Nurrbzr, "and "Data" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) spceificC .r. pcrrit. Retain copy for yo.~r records.
<br />t4.. More detailed ins7uctions for use of t•:+s 17isa/' ~,,~~ ai.ni!or-r,r 2r.rt (D;;71~ fa~-n may be obtained from Ctiice(s)
<br />specified in permit y
<br />e
<br />i~ ~~~ 1`Tr-n~-';-erg
<br />~~r._ ~__ A ~ t,,.;.~,
<br />Tlils report is required by law (33 U.S.C. 1318; 40 Q.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; nr in criminzl 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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