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~~~erwork Recle:ction 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 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 instmction dvected at entry of that information ah•eady
<br />preprinted.
<br />2. Ent:r "Permittee Name/Mailing Address (and facility name/location, if different)," " Pzrmit Number," and "Discharge
<br />Nur.rber" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning aad editing "Monitoring Pzrird" covered by form where indicated.
<br />S. Enter each Paromztzr" as specified in monitoring requirements of permit.
<br />5. Rnt:r 'Sarr/~lz rblearr;r~ramt" daha for each parameter under "Quaatiry"and Quality" as specified in permit. 'Avrraor" is
<br />nornally arithmetic average (geometric average for'oactcrial parameters) of all sample measurements to each pa©metcr
<br />ob'::ined during "rV,aritrring Pzriod'; 'SLfaximum" and Mini,;;um" arc nomally cr.trcme high atd low measurencn[s
<br />obtained durirg ",:P.n•'[-,ring PerioJ". (Note to municipals with secondary treatmrnt requirement: Enter 30-day n~:era;;_
<br />of ean•pl~ m~asurem^_nts under ',1v:r:rg~,"and enter rra;cimun 7-day average of sr ~ple measurements obtained d~.rng
<br />monitoring peiod under "iLlarimum.")
<br />6. Ent.r "Pz~-,rti! R,.•4uir~r,verJ"for each parameter under "Quantity" a-.d "Quality" as specific;: in pewit.
<br />7. U~ 'r. "T''. !: " c-t number of sample mxst~rcncn: during monitorn~ period thri c-.cccd ma rimr.m (and'or mini,r,m
<br />cr ^, -day average as appropriate) permit requirement for each parmetcr. If nonr_, enter "0".
<br />t{. °it_r "Fra;•~_r._y cf.:rz_dpsis" both as "SomFl~ d,"astuz,.t.,tr" (actual frza,u~acy of sr ,tpfing and an:_lysis used during
<br />mo Tito: ing period) aid as "Pzr;,rit Regvira%uent" spec tied in permit. (o.g. Snter "~a+r,"for continuous monitoring, '7/7"
<br />for ono day per wce',4 "1/30" for one day per month, '7/90" for one day per quarter, etcJ
<br />S. Entxr "Sm;rp!. Type"bath as "Samplz /.fzosra•eutze!" (actual sample tic nscd duriro monitoring pericd) and as "ParTtit
<br />Rz;uirama,;r," (e.g. Rntcr "Graf" for utdividual sample, "24H':" fcr 24-hew compos~te, "N/A" for continuous
<br />monitoring, etc.)
<br />'0. t`>'~crc violations of permit requirements arc reported, attach a brief explanation [o describe cause and corrective actions
<br />to he taken, and reference each violation by date.
<br />11. T~"no discharge" occc-s during monitoring period, en?cr'T'o Discharge" across fcrru is pace of da?a cn~*y'.
<br />12. En?er "Narn:,Titi~ of "rirrcipa! Es.:,,vtiv~ Gffi_~r" vrith "SigraEarrr of Friu.•i~al Es~~u[iv,a (.~c•zr cf Aulhorizzd
<br />Ag~nl, ""Tzlephona Number,"and "Dar;:"at bottom of form.
<br />13. Vail signed Report to Office(s) by date(s) specified in permit. Retain copy far yos records.
<br />lr!. Mar detailed instructions for use of this Dischrge ,14~nirori~g RerorT ~DinR) fo~~n tnny be obta~ncd f-om C~'ficc(s)
<br />specified in permit.
<br />~e~al ITT©trc~
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure [o report or failure to report truthfully can result i^
<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)
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