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~'~perwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hou-s as an,
<br />average per response for some minor facilities, to 110 hotus as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 1 S hours per response, including tune 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, lnformation 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 that information already
<br />preprinted.
<br />2. Enter "Permittee NJrrre/Mailing Address (and facility name/location, if different)," "Permit Number," and "Discharge
<br />tlrumbz/' where indicated. (A separate form is required for each dschazge.)
<br />3. En[cr dates beginning and editing "Monitoring Puiod" covered by form where indicated.
<br />4. Enter each "Fn•anr~~h~r" as specified in monitoring requirements of permit.
<br />5. Enter "Slr-,~,rlr rvi_asurument"data for each parameter under "~uantiry" and Quality" as spccifie3 in permit. "Average" is
<br />aontally arilhme~ic average (geometric average for bacterial parameters) of all sample measurements for each par:unete-
<br />ob'a~ned during "d ,nit~,ring Period"; 'S;I~.rinxun" and rY;ininnnn" are normaliy extreme high znd low measurements
<br />ohta~ncd c~~~ro ", ..,„irs~ tab period". (tote to m•!nicip?Is with secondary treatment recuirencnt: ~ntcr 30-day average
<br />of sample measu;zm:^:e under 'itverag~~,"and enter maximum 7-day average of sample measurements obtained du -.~
<br />monitoring period under "ivaxinnnn.")
<br />G. Enter 'Pa, : h li~:1,ri~_,nant" :or each parameter un&.; "Quantity" and "Q~ualiry" as spccificd in purmit.
<br />7. Ur]:- "I~iL C. " em_ ~ .~unbe: of sc;np:e :ncaeurc~nua du,zng moni.o^:ng perod L'iei r,ceed mt;:inur~ (;,nd4,r niir` -.,m
<br />o- 7-day 2' c,aoe as a_ ~ropria~c) pcnnit regniremeni for each parameter. lfnone, entc* "0" ~
<br />C. L-o~cr "F,s,.ur y' /J',:.(~ry.,i "both as "S_';:rF!e /'fL.'Si','Jll(:I:!" (actual frequency of sampling and raalysi::.~s~: during
<br />i-.unitcringpz.iod) ~~d c "Fe,;..i; R.lui.~s.~u;u"spccificd in pcnnit. (e.g. pntcr "~rr;," :or continrous monitoring, "!/7"
<br />for ore d:.; pc; ivr;:c, "I/30" far one day per monLr, "!/90" far one dzy per quarter, etc.)
<br />9. ,=n: r "~ ~..-,-L• 7},Fs.' Lo:h as 'SrapL ~:-~eaa urac~_nr" (actual sample t;~pe used dur:co monitoring period) and zs "Prnnit
<br />R~,ruiremaar," (c.g. ~ntcr "Graf" fornidividual s2:nplc, "14/l~" for 24-hots composite, "Ar/A" `nr contiioous
<br />monitoring, etc.)
<br />10. 'i,'hrc v;o'uiu~s o; r,_r.nit *equi:~erucnrs arz nror~cd, af_ach a bref explanation to descrhe cause and cortzctive actions
<br />to be take, and reference each violation by date.
<br />11. 1; "^.c disc:: oe" uccvrs during m.cni tu:ing period, enter "No Discharge" across form in place of data _nny.
<br />12. ?;nter "N,•„l-,Tif.'~ of FrinciFa! Exe~r~tivd Ojjedr" viih "S%ratnr~ cf Prin_ifa? E-e~utive G~cer ,JAulho,i.ad
<br />Agart, ""T.L•f ~;cs ~r'rrorbzr,"and "Gals" at bottom of form.
<br />13..: tai; ;ignc~': azpm i to C.~ rcc~s) by datr(s) specified in pcnnit. Retain copy for your records.
<br />. ?•:c. de' -_ nstn~clions for use oPthis Dischar~;= iiisnitorirrg RF,rt (Divr7~ farm may be ootcined from C~cc(s)
<br />specified in permit.
<br />
<br />This report is , equired by law (33 U.S.C. I318; 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 fo 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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