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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 fot reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Envirotunental 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, llC 20503.
<br />General Instructions
<br />1. If form has been p~utially completed by preprinting, disregard instruction duetted at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/Mailing Address (and facility name/Iocation, if different)," "Permit Number," and "Clscharge
<br />NtrmEer" where iralicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginni rg and editing "A:onitoring FerlaJ"covered by form where indicated.
<br />4. Enter each 'Parameter" as specified in monitoring requirements of permit.
<br />5. Lnter "Suriple i 4,:asurer.+zn+" data for each parunetc; under "Quanliryr"and duality" as specified iu permit. 'ilrer-aaa" is
<br />normally arithmeti;: average (gcac'et-ic average for bccterial p~~rar,.ct_rs) o"all sam;:'o measurements for each pszreter
<br />obtained du~irg "Ai.r%luring F~,,i~ci'; "ni~r-icrv,a" any ;di,ii,mn-;" arc normally e:.'rene high and lo'.v measur_meut;
<br />abtaine9 ;luring ":r(~nih ring Pa;io a". (A'ete to muaicia,ls v.'ilh secoodr ~ ireaht°,.+ rcruirement: L-nler 30-day a•rc age
<br />Of Sw]'~?e mCCSLrcmenis under "IILYr9,y'G," and enter n:~ximon 7-day &JLr3gC 0~ L~;iRptC meaSllrerlJiliS Obia7ncd dL'-ing
<br />ctenitoringperiod under ".Licuimurt.")
<br />b. error ';'~, „vr lZ';trramerr/"for eaeil par.al'CiG and<' „~l!~61/IN"P^.d "L 11 '/I/~1" a5 s; CCTlled In pt'i7ri`i.
<br />7. Cndcr "~ru Cc" cote- nur.,cer ofsampl:: moos ~ramwt doing .non :crin;; ~=ricd i1 .. .:coed maximwn (wnd/ot min' zam
<br />e: 7-day er'c-age as apprvpria.e) pc~i; rcou::e~r...! iur each p:u~n_:er. ;f none, carer "0"
<br />8. _..:cr ',%',~~7uar-y cffLralysa"bath as "S_~ar !_ ,'~;r.~s~~.z;n_.;!" (a_tral ~ .;c,u. ~.ey u,';,ampling and snz!ysis used during
<br />.~ c itozn~ period) and as "Ter„ut Re uirr;,tc,u" sreclGed in pe-.nil. (e.g. manic- "C~..rt,"for continuous monitoring, "!i7"
<br />for one dad per wee':, "1/30" for one day per moaGi, "I/90" far onz day pe; quarto, etc.)
<br />.n:c:
<br />"S-i,rj (_ T}Fa"both as "S~ a~ !r ri•Lu •.~s,aa:~" (aqua] samn'c typo used durnl; mooitorng period) and as "Pa,7nit
<br />Rs.luiremzat," (e.y. ~ntcr "Cr-.~h" for individucl simple, "1tili~"`ur 24-hour conposi~c, "N/A" for continuous
<br />monitoring, etc.)
<br />I0. P~'heie "iolations of perriit requirements are reported, attach a brief e::planatiai io describe czusc and corrective actions
<br />to be taken, and reference each violation by date.
<br />1 1. :f",io discharge" occurs during monitoring pored, cuter "ido Discharge" across forcer in place ofdata entry.
<br />]2. Enter "Naote/Ti!!e of R-inoipa! Exaculiva ~~~,-" with "SignaLrre cif PoinciF_~l L•.renrtivs ~cer of Authorized
<br />Agent ""Telephone Number, "and "Lhte"at bottom of form.
<br />13. iv:ail signed Report to Office(s) by date(s) specified in permit. Attain copy for your records.
<br />14. More detailed instructions for use of this Discharge rLloniloring Report (Gbh form may be obtained from Office(s)
<br />specified in permit.
<br />Legal 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 cam result in
<br />civil penalties mot to exceed $10,000 per day of violation; or im criminal penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment for not more Phan one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03!99)
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