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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, 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 />I. If form has been partially completed by preprinting, disregazd instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permiltee Name/Mailing Address (and facility name location, if different); " Perini! Numher," and "DEscharge
<br />Numher" where indicated. (A sepazate form is required for each discharge.)
<br />3. Eater dates beginning and editing "Ivfoniloring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. L-n[cr "Sample Mzasuremznt" data for each parameter under "~rrantity"and Qt~olity" as specified in permit. Averogz" is
<br />normally arithmetic avemge (geometric avc;uge far bacterial parzmeters) of all sample measurements for each partmefer
<br />ubiained d;uing "hLnitoring Period'; "i,1•niruun" and itiiini+num" arc normally extreme higA and low measurements
<br />obtained dw~n~ "i,donitoring F~~iod". (Dote to .~niripals jai?h secondary traimsnt rcquireme~t: ?ntcr 30-day average
<br />of simple measurements under iiverage,"and cats n:::imem 7-day average of sample measurements obtained d~,;tg
<br />monitoring period under "tYiaximum.")
<br />6. L-ntcr "Pen:ri[ Reyuirzment"for etch parameter ureic; "~v:*+vity"and "quality" as specified in permit.
<br />7. UnCr "Arm ri' enter ntunber oC sample measurement r:wiug moniio~ ing period that ezcccd maam~.un (ana/er mini ^um
<br />o; 7-d::y a~crag;, as aapropriate) permit reyui rcmcri for each parameter. If none, enLr "0".
<br />8. Dater "!''r. ~u~~,~ ofA.ralysis" both as "S r.~p(z ;~fs_~sr•: z~csr;r" (actual ,rcyucnc}• of sampling .u,d analysis uses during
<br />:ronitoriogperiod) and as "Fa~;rii Re.lui~~.aeni"spcc~ge3 in perm:. (c.g. L-aier "~:~,t,"for continuous monitoring, "!/7"
<br />for on :day per week, "!/30" for cne day p;,r montir, "1/90" for one day per quarter, etc.)
<br />9. Eute: "Sa,up/z Type" both as 'Sample d•:asr~•cavan" (actual sa rple type used dw~ng monitoring period) and as "Pa-nrit
<br />f4 yrrirzment," (e.g. Enter "Groh" for individual s~aalc, "1IIfC" for 24-hour composite, "T//A" 'o: continuous
<br />monitoring, etc.)
<br />10. lx>3ere violations of permit requirements are repo,-tee, :Mach a brief explanation to describe cause and com;ctive actions
<br />to be taken, and reference each violation by date.
<br />1. If "ao dischage" occurs during monitoring period, eotcr'4•.To 17iscL•arge" across farm `a place ofdata eahy.
<br />12. Enter "Nam/Tidz cf Principal Fxacutiva G~3'i.;~" with "Signo!trre of Prin_iFa/ EX.'oT!llVe Cfficzr of Authoriszd
<br />Agznt, ""Telephone Nunrher,"and "Dori"at bottom of form.
<br />13. i~iail signed Report to Office(s) by date(s) specified is permit. Rctaus copy for your records.
<br />,;. \~o-a dciailed instructions for use of this Dischargz itsaitcring R.~po~? (DiiII~1 torn nay be obtained fiom Oflicc(s)
<br />specified in permit.
<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 yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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