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Paperwork Reduction Act Notice
<br />Public reporting bwden 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 bows as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 1 S bows 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 bwden, to
<br />(Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 204E~0; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If forth has been partially completed by preprinting, disregazd insWction duected at entry of that information already
<br />preprinted.
<br />2. F,nter "Pennittee ht7me/Moiling Address (and facility name/location, if different)," "Permit Number," and "Dischmge
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Pzr iod"covered by form where indicated.
<br />4. Enter each "Param_t~r" as specified in monitoring requirements of permit.
<br />5. Enter "Sample !/,z.rsu, zinant"data for each parameter under "~umniry" and k.ualiry" as specified io permit. "Ava, zoz" is
<br />normai(y arifunetic a+: c;agc (geometric average fat ba_terial parametc:s) nail samplr, ircasurcnents for each paremat~r
<br />obtained du,-ing "tri;,lilOrll]g Pzliodrr. rnV/J_Cll;lt!lU" and /1'ilil!litt!1,1" a'if 7C Rnally CSiiCmC }Ilgh an4 IOW 7TP.aRllrCmC~tS
<br />obtained dwirg "hl~aitorin~ Fzli:d". (Note to mea~c pals crit'1 sccoudary treatlnert rTuirement: Enter 30-day z+~c-a~e
<br />oCsample mcasu-cments under ".lvera~e,"cad cn'rr -~;;imum 7-day avc;agc ofsar;:'c measwcmcnls obteinzd during
<br />monitoring period under "rLiaxintlm.")
<br />5. F-,nrfi "Per;;,i(R.r:/l/li zn7';II"fn: each param~:i.',r 1111':LT"~I/.il'.(!tj'"i-"1L"r~LKlllh~n.'LS :~CCItIfd lil CC1'Lll `..
<br />7. Um_'..: "P/o Fc" en~cr number of scm~lc mr°suremen• during ~roiitc-ing ~erind ti^1 ~~~;cred ,~~'!ximum (cnd,'ar ni*,~ ~~en
<br />or7-day avc-2gc as rppropriate) _rmit rcquir.-scot for each parameter. if Hong enter "0".
<br />0. Ec:;r "Fr,rl!!,cny nf,Lla/ysis" both as "~ ~,;; !a 1.; ~JSrn _;aznl" (acffial f wucrcy of sanpling cod 2malysis used ~ ,r ng
<br />monitoring period' and as "Peo,:it R °;ui:-t,r..,l!" sperif;,:d i^ pc~~ni: (e.g. linter "~~,n!,"for contnuous .ronito;ir~, "1 /7"
<br />for one day per v: cdc, "1/30" foe oac day per tconth, "1/90" for one day per quarter, c!eJ
<br />9. Ln?ar "Ssrlr/~ Ty1~z"both as '(S_;~!r!s :L,'.v~~ . s,,,_,: ~" (a=teal sample q~pe used durng :ronitor.n3 period) and as "Pzrni!
<br />Rquh-~inelt," (e.g. linter "Glnh" fer individual s:.mple, "?41/C" fcr 2A-hour composite, "IJ/A" for continuous
<br />monitoring, etc.)
<br />! 0. 1'Jhere violations of Hermit requirements a~ z ;c; cr:.-d, attach a b,~eF c;:planation to dese.ibe cause and corrective actions
<br />to be taken, and reference each violation by date.
<br />11. If "no dischazga" occurs during mocito ing pal-icd, enter "R'o Dischazge" across form in place of data entry.
<br />12. Hnter 'Name/Tillr. of PrinciFal Crz.:utiv: O~~er" with 'Signatw-e of Frin iral F_rscutrva O~czr of Authorizzd
<br />Agent, ""Telzphone Number,"and "D,~te" at bottom of forot.
<br />13. Mail signed Repoli to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Dischalde ~Yfonitoring Repoli (DiY1R) form may be obtaine3 from Office(s)
<br />specified in permit.
<br />~.egal Notice
<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 im
<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 far not more than one yeaz, or both.
<br />EPA Form 3320-1(Arev. 03/99)
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