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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 hows as an
<br />average per response for some minor facilities, to 110 hows 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 time for
<br />reviewing instructions, searching existing data sowces, 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 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 "Pzrnittee Name/Mailing Address (and facility name location, if different)," "Permit Number," and "Gischargz
<br />Nmnf•sr" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates bebrinning and editing "Monitw-ing Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample N.aasru•zmant"data for each parameter under "~u;nl.'ih•" and z~rralit)~" as specified in permit "Ara' ~s~" is
<br />normally arithmetic average (geometric average for bacterial pan,.lnctels) of all sample mcasurmcnts far cacti parameter
<br />obtained during ",V,-.;:i~or+;r~ Period'; 'SLLI_cirnum" end rYlia%„uu,l" a-c normall~• ~;h,mc high and low measurements
<br />obtained dwvlg "~,1';ui!:,,-i%rg Rn ;.I". (Nate to m•anicinals vdith seconr'ar}' traatmcnt rc luiremcni: 1:'n-ter 30-day we-age
<br />of sample mesurements ender "Aver ~o~ "and ca^.cr -•~rmum 7-dcy :.vemge of s.:rn'c mcaswemen's obu~ined during
<br />monitoring period under "Maxirrrnn.")
<br />5. Enter "Per;rit ,&:lui,-,tmz:u" Por each par•amctcr under "~u.;-ri~)~"anc, "~rulih~"as s•:ccifed in pctziti:.
<br />7. Ihdcr "A!' Es" enter nvmbar of sample mcasurcmr--1t during mo~it;~n'~ r.crioc' fFil ~ :c^.d m _ximum (1nd'ci ~lir~~n•r~rt
<br />cr 7-day avc ~~: ~s rppropriate) permit requi;.merd for each parameter.Vl. nocc, e'rcr "0".
<br />~. Enter °f rzlt': iiCy ~'f rt/i!/y5[S" bOLI LS °S llfi~Jd !vl 'l'!','_n,~'~+t° (a'.;tual f'--.:Clq.^f Cy^."SLmpiIP~ and anNl~ 515 used LL:~n~
<br />mC~lltnrlil~r•, perod) ar,d as "Pz,rrit R.'?trirz,.r ra!" spcri Fed in pe.niir. (z.g. ;':;;a' " :,rt," iar centiuuous monitorin,;, ".r/7"
<br />fcr anc day per ~: cc'<, "1/30" for one day per mant7l, "1/9L"' for one day per quaRCr, ctr_,)
<br />9. ~n;er "S.lr, ~!e ry; ~° both as "S-:r,:Fls ellzasra~a;;7.,.r" (ecr~al sample type used dining monito-;ng ncriod) and as "Pr;nr!r
<br />Rr7ai.-arae'a," (e.g. Winter "Graf" fur individual s; ~rpL, "2411" fa 24-l.a~r composite, "il'/A" for co~tincous
<br />monitoring, etc.)
<br />10. !'/here violations ofpcrmit requ'vements era reYCr[cd, ariach a brieEc;;ptanation tc dssc:ibc cause tnd ccrcctive act;ons
<br />to be takee, and reference each violation by date.
<br />11. I. "no discharge" occurs during monitoring period, enter "No L`ischarge" across form in ~lacc of data entry.
<br />IZ. Enter "Nam:JTitle uj Pri:rciFal Executive G~_•~r" with "Signature cf Erin ~iF11 Erd_uliN' O~~zr of Aurl+;;-izz~.f
<br />Agent, ""Teleplronz Arumber, "and "Date" at bottom of form.
<br />13. Mail signed Report to 01~ce(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More dutailed instructions for use of this Discharl;a Norritoring R.rpv/r' (C,1~ farm 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 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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