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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 bouts 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 Instrnctions
<br />1. If Form has been partially completed by preprinting, disregazd instruction directed at entry of that information aUeady
<br />preprinted.
<br />2. Enter "Permiltzz Name/Moiling Address (and facility name location, if different)," "Permit NumEer," and "Discharge
<br />NumFzr" where indicated. (A separate form is required for each dschazge.)
<br />3. Enter dates beginning and editing '4Lfoniroring Fzriod"covered by form where indicated.
<br />4. Enter each "Parameter"as specified in monitoring requirements ofpermit.
<br />5. Enb.r "SaatFlz ivla:asurrmznr"data for each parameter under "{~eraeriry" end Qualily" as specified in perm. "Average" is
<br />normally arithmetic average (geometric average fot bacterial parameters) oCaII sample measurements far each parameter
<br />ob:aired J, ring ",1 f,rritoring Pzri%d'; ",44~sirurm" and ir:i»innim" are normally extreme high and lo+v measurements
<br />obta nod r'.• ir.~ "; : ;,trr :rind Perioc/". (Dloce to municipals with secondary treatment requirement: Enter 30-day average
<br />of rumple msu--mints under "~ir~;a6~,"ctd enter maximtun 7-duy average ofsantple metsttrcmcnts obtained dur g
<br />monitoring period under "iraximum.")
<br />5. limo "Per, ~'; Iv.,rrt: ~n,~at" for each parmcicr under "~tran/iry" and "Qrality" as specified in Cerrnit.
<br />7. li: ;: "A'c /`. " crl.~ . ,~.bcr of samp'c mc~.~:cmcet d_ tg mo^iloring period iil:.' excee3 maximtra (L'.C:'or ^ i,:', m
<br />o- ~-dsy a~•c-a~~ t~ a;.1roprire) pc]nrit rcquiremenl for each parameter. If none, cater "0".
<br />8. r_'id•_I' "~,_,, ..y ~~'.:.-.~lysis" b~:L rs "°_•ari r. ii' ,~etr,-emrnt" (ac:ua] frequ~r.cy of sa,apling and ana'ysis user; during
<br />~-anitn~ino Ec;iod) ar9 rs "Fan,:i~ R~.ird,~an_r,r"specified in ,]civtir. (e.g. Grater "Crr,r,"for continuous moniwruig, "1 /7"
<br />ror ore dr, per r~_c::, "!/JO" for cac day par :nontt, "1/90" far one day per quarter, etc.)
<br />i. -vier "Sa.,. I: T•F_" ;.oih zs "S~.a~ (a i/,aasrr,Ymsrt"(actua: sample type used du+iog monitoring pered) and as "Per,.ri!
<br />I_;rriramc,rt," (e.g. 3nt~r ";rah" for individual sample, "2~iH^" fo; 24-hoer composite, "N/A" for continuous
<br />monitoring, etc.)
<br />] 0. P,"urz v:c' liens o'p ~-1:ii rcqu~remcnts arc reported, at~ach a brief cxpla~ation to drscr;be cause and CO Txirve c:ba05
<br />to he taken, and reference each violation by date.
<br />l 1. '. 'ru disc's. , oe" oca .a during reonito,ing period, enter "A:o Discharge" across form in pace of data entry.
<br />12. Ente, 'T.C,.•~/Tviz rf Frin;iT.t E.:e,xrtive O~•dr" vrilh "Sibnaau•e rf PrnrciFal 1:.-setrtivz O~~er of Attltcrizzd
<br />.4grnt, ""TelaFis.t.: IJr •mtar, "and "Gat_>" al bottom of fomt.
<br />13.:,;3:' ;ignc•_' :.epos i to C u ic:,(s) by date(s) specified in pemtit. Retaui copy for your records.
<br />1=. '.'n dc~;'r~' utsWctions :or use of ibis Drirfr.r;~z ivL~ailarinb Rsf~rt (DivrRJ fort may be oh~ioed fmm COIw(s)
<br />spccifed in pcrrnit.
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or Cailtue 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 yeaz, or both.
<br />FPA Form 332Q-1 (Rev. 03/99)
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