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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 1 S 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 Stteet, 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 />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already <br />preprinted. <br />2. Enter "Pennittee Nume/Mailing Address (and facility name location, if different)," "Permit Number," and "Giscl~arge <br />Nun76er" where indicated. (A separate form is required for each dischazge.) <br />3. L•'nter dates beginning and editing "Monitoring Pariod"covered by form where indicated, <br />4. Ln[er each "Parameter" as specifted in monitoring requirements of permit. <br />5. linter "Samna N.'zo.r7n-au7e;rt" data for each parameter under "Qumrtity"and ~ualit}~" as specified in permit. "Ave:aaa" is <br />no-ma11y arithmetic average (geometric average for bacterial pzsmacrs) of sll samplu measurements for each parameter <br />obtained during ",bi:air;ri+7g FerioJ'; '7/..~a~in7er7" znd !.>ini,runu" are noRnally c;ar:mc high and low measurements <br />obtained during "+:~-.rul~,.-i;tg P~rixf". ('Vote *o mu-icinaLs vnt(-~ seeendary trcalncnt rc~uirem~nt: _?nter 30-day ave-agc <br />of samnlc mcaserema-'s under ": v_r~ ~ end en'cr -~~zir, um 7-day average of sin;'„ me~su crc~n's ~h;ui~~d during <br />monitoring period under "ivlazimt7m.") <br />J. ;'stir '.°zr%;7It n?~A'ir'LU16a/" f J; each ps:an+c:zi IIIICCr "iiG7:7:ir'O.:G.ai "L#1!i ~'" a5 :'peciued in permit. <br />7. Uncle; "Plo Ez" cn`.r cembor of sam?le mersure~cnt durng men%taring prriad tiiat :::eccd maeima-n !rnd'er c~inimu-*~ <br />cr 7-day avcrtgc as z?prepriatc) pemit rcyuircmcnt for each parameter. If none, enter "t7". <br />8. Lntcr "Fra,lve+~ ~ ~,f?,r.71~sP."both as "ter ,-!.: ,fvsr;~.n~nr" (och:af frequcrcy c°sanpl~n~ end znrlysis used :'firing <br />moniutrir,,; prr cd) . nd as "P ~.;::fir R~~; uir~, ~ =,r+" s,,ccifed in pc, ~r;it. (c.g. Lntcr ',.•..7t, "for cor,Enucas .-nor,itorin~, '7/7" <br />for one day p.r week, "1/30" for one day par month, "t/90" for one day rr.r quarter, rte.) <br />9. .rimer "Sa7.rFl_' T;yti?" boi't as "S~;r:%t_ n' .'sr'.-~;:r"; ~" (r'.n!al svn?Ic type used deri.ig tronitoru g period) a^d as "I'e::,:%t <br />1F~guir,a:.a," (e.g. ;inter "G,~l-" fur i-dividual s^mplc, "2411" for 24-hoar cmnposite, "r`w%A" for continuous <br />monitoring, etc.) <br />10. ~\>lu:rc violations of pe nail regrirzmcats a; ~ iuoortcd, attach a brief ezpl2n :tiny to dcsc;ibu cause and corzctivc actions <br />to be taken, and reference each violation by date. <br />11. If "no discharge" occurs durng mcnitorng period, cn?cr "I~'o Disc;l;arge" across furrn in plzce of data entry. <br />12. Later 'T7ame/Till_' of Friucir:71 lr..:re!iva r~.:_'r" with "SiKrrateua of Ain.:iFv( 4'rscutive O~~er cf Authoriti~,y <br />Agent, ""Tzlepl:rn7z Numl-er,"and "L'ate" at bottom of form. <br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records. <br />t4. More detailed instructions for use of this Discl~argr Monitoring Repo+4 (GMRJ form may be obtained from OtTicc(s) <br />specified in pertnit. <br />~.egal 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 imprisotunent for not more than one year, or both. <br />EPA Form 3320-1 (Rev. 03/99) <br />