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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 hotus 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, seazching 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 Folicy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S. W.
<br />Washington, BC 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, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permitlee NamelMoi/ing Address (and facility name/location, if different)," " Perini! Number," and "Discharge
<br />NumbeJ" where indicated, (A separate form is n:qutred for each dschage.)
<br />3. Enter dates beginning and editing "Monitoring Fericd"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Se,aple iilessure,:r_nt"data for each parameter order "~u~ntiry"and Quality" as specified in permit. 'Areroge"is
<br />nomally arithmetic ave,age (geometic overage for bacterial paramet_rs) of all sampl: measurements for each prr re:cr
<br />obtained dw~'s.g '7r;:,i,.ririg Period'; '7/;1xi,m~,a" and :,rmi~,ur»I" are normally cxtrcne high and low mcasuernci:U
<br />abC~incd doing "d•is,ri2,ing P~nc_+". (1~btc to municipah ~+•irii secoruary trcatm~"t nquircmcnt: E~~tcr 30-day atccagc
<br />of sample incase-ements under "Av.. moo.,,"and eater m~imum 7-day average of scnple measurement;, obL: acd d_~ ing
<br />monitoring period tinder "iviazir,Jttm.")
<br />O. E.er 'i'~CriiJll 1te~Pirelnelll" "Or Caen pafamciei (Ind CT "LY'il!lt~~".^d "QlloifN° aS spcclrled m pcrm!~.,
<br />7. Under "No F..r" ells au•nbur of sample r,ensure:nrn[ du;ir!g rx.nitor~~ p~,icd tha'.:.ccead m~rimum (and/or im,~~mu i
<br />or 7-day e: cr~ge as approprate) pe-nii rcquire~nc,a for each parameter. i ~ none, toter "0".
<br />8. ~r:e- "Fre7u.,r_^,, .~'gn~l~sis" both ~s "S1,nFi= ,i6~ ~srr +~.a" (e_tual f equc^cy o" se.npli~io crd anz'ysis !used r,~r'og
<br />monitoring period) and as "Pe,„tit 2_j1L•z:,rcni"specified in pcrm~L (e.g. Ente: "C;,t!,"for cantinuoLS moni;oring, "1 /7"
<br />for one day lxr v. ec':, "1/30" for one day pc.• month, "1/90" fo: one day per quarto., etc.)
<br />9. Ec~r, Samt~le TyFz"both as "S *.ap(e ,~'t~s:r; ~,ne,l!" (actua: samptc type used during monitoring period) and as "1 dndi*
<br />k~gJair.:me,iJ," (e.g. Eater "Gi•o.^" for individual sample, "2411.:" fo- 2ti-bou~ composite, "rV/A" ;o; cov+inuous
<br />roonitoring, etc.)
<br />10. F,'here violations of permit requirements are reported, roach a brief e;epla~,aticn to dcsaibe cause and car: ective actions
<br />to be fatten, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring pcricd, enter "ido Discharge" across form in place of date entry.
<br />12. Enter 'Name/Ti!le of Principal Ec~ctJNt^~ O~~.r" with "SibrJaJara of R-in~ipal Le~aetiv: G~car uj Aar;:crcr_!
<br />Agent, ""Telephone Number,"and "Date" at bottom of form.
<br />] 3. Mail signed Report to Cfuce(s) by date(s) specified in permit. Retain copy for your recorcL,.
<br />14. More detailed instructions for use of this Discharge I~fonitoring Repor! (Dll'i'I~ form may be obtained from Cfficc(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 e;cceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment foe not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03199)
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