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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 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, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pernrittee Name/iYfailing Address (and facility name/location, if different)," "Permit Number," and "Discharge
<br />Number' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Mnnir~ring Peri ,l"covered by form whcre indicated.
<br />4. Enter each 'Parameter" as specifed in monitoring requirements of permit.
<br />5. =inter "S^n.r/~ i:Sea!rrenlerv" dzta ror each parameter under "Qum+ily"and ~uali!)+"as specifcd in permit. "Aver Aga" is
<br />romally a,ithmerc ,: _ra6e (gecroctAc average fol bacterial psrmeicrs) cfall sample measwc.nen's :or carh pr~a'letcr
<br />o:;tained du*i,-.g ":L;:;:~;o,ing I'zri,d"; ",Ls~~~,uunr" and rYlinin;ur,," arc vo;maliy c~n_nc high and low measruem•:ns
<br />obtained dining ', ::uiF.r my reri•.J". (1~ote to mu:.ic~pzls wilt sceoudary trea+l-nczt requirement Winter 3C-dey avcra;,~e
<br />Of °,r:P~+C m:rSUiCICCC.iS UPL( "AV3,71,'a,"cad en:cr ,*~c,cimum 7-clay avc~zge ofszn_ 1a me2surem~~rts ob+~^in ci ~u JI~,~
<br />moniloringperiod .order "iviaximut>z.")
<br />o. -.''c' ".-,:.-.;-i!i2e7ui.-=„ran!"for eachparamcier~.ulc'_-"~v.+)!/ih,'"a~: "Qr!~Yry"ass;.rci~iediiermlt.
<br />7. C~u'~.r "P/•, ,Y.:" un•c~ nunbcr cf sample nc.i;Ureircnf -luring ;lionRc, i rg; rrind ti,ct ~.cc.:d maxi:nura (r r.d/cr i li''~:wir:
<br />c. 7-de •; avat,+,e ~; ~ppropriatc) ;.crrni~. rcyuircme~i for each puram.icr. IF none, racr "0"
<br />8. Ee:cr "fYa:1%•e~r::~ cfAazl,'c+," ;;nth as ".S~,.li !~ rLL_+cr, :,nrnt" (acfial fioqucnry u' ;c poling rnd zoelysis •ised during
<br />moniio~ng pered; ._ .. ...,,ur fu:+uirer. _•.t+" sf,eci'icd in parm~t. (e.g. rntcr ".':on!," for cc,li;nuous ^-ou toriig, "l; 7"
<br />G.r anc 'hJ ps. o, cu'c, "1/30" for one day pcr month, "1/90" for one day per quarter, erc.)
<br />9. gin;:r "S. v; rF!a Ty7 _"boCt c "Sa,•rFl_ nor, ++.a t;,; _,~+" (actual sample type used during monitoring pain;':) and as "?~, ;,!i!
<br />rtz~i!!lydi7lc'.: !,° (e.g. Enter,":,rib" for IildlV ld Ual sample, "~'/ii~" FOi 24-ilOL~r COmFOSIte, "iJ/A" i0r COn:L UOLS
<br />monitoring, etc.)
<br />r 0. P/bere vielaho-rs of permit rc~uir_ments are ,_ported, a±tact a brief explarmtion tc dsc:ibe cause and. corrective aci~ ~s
<br />to be taken, and reference each violation Sy date.
<br />1 1. IF"no discharge" occurs d~rin~ mcc`.to~ng pcriec;, en.a "1~'o Discharge" zcross form in place of datz entry.
<br />12. Enir "N1,a,:/TitL: of Fri;riral lixewrtira ~~_," with "Si;,mahrre of Prrnci/rl! Ea~cufiv~ O~_zr cj F.vlhc,~iz~~
<br />Agent, ""Telephone Nurnl-e,;"and 'Date" at bottom of form.
<br />13. \~ail signed Repot ~ to Or~lce(s) by dztc(s) specified in permit. Retain copy for your records.
<br />]4. Mare detailed instructions for use of this Discharge ,41~niloriug Report (Drtif~ form may be obtained Eom CiFcc(s)
<br />specified in permit.
<br />1Legal Notice
<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 fcr not more than one year, or both.
<br />EPA Form 3320-1 (F:ev. 03/99)
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