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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 for reducing this burden, 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 />1. If form has been partially completed by preprinting, disregazd instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Penrtittee Name/Moiling Address (and facility nameflocation, if different)," " Pennit Number," and "Discharge
<br />Number" where indicated. (A sepazate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each 'Foram°ter"as specified in monitoring requirements of pemtit.
<br />5. Enter 'Sample Measurement"data for each paramc?er under "~.u!ntih,~"and ~uoiity~" as specified in permit. 'Av~r.ds" is
<br />narmally arthmetic average (geometric ascrage for bacterial pa-amcters) of all sample ncasur„ments for each parameter
<br />obtained durir,~ ",bl.nit.ring Peri;,l"; "rLloxirun;t" and dli,rirnrun" a-t normally cxtr,:me l;igb and loa mcasur.mcats
<br />obtained du\~ing "-.fonit;.-iua Peri•>d". (TVote to mm~icinals c:iJt secaadaT treatmrd re: uircmcn[: Enter 30-day avenge
<br />of :ample mcrsurements under "Av~rlgz,"and eater ~~ aximum 7-day ave,a~e o. s[.rrp!a mcasurrmca'~ ob pined durng
<br />monitoring period under "ivlarimutn. ")
<br />5. ~nra. :°~.r.;it ~c,:7ur,-~mznt"for each paramcicr und_r "~tt~ntip ",L d "Qum/i,~" as ,;;ccificd in pe,-mit.
<br />7. Under "A'•. Cx" enter number n. sample measur newt during mmifa: ink ~c;iad t'-.\.t c :c .d maximum t~nd/cr r ~in`n~~\n
<br />cr 7-day ave ~~c as 2;:prcpriate) :.unit -uquiremrt: for zacn pa ammeter. I. none, cute "0".
<br />ij. '=n'"r "Freer ~ncy ojAn~lp.ris" burn as "Sa.;;-Ir ,t•f_v:,,: ~,.;~.:t" (nct~ai f'cqucrcy : r sampti g and analysis used r•.;ing
<br />monitoring pcrod) and as "Penal! 21uire;;:',at" sr cified in pcrrnit. (e.g. `:Hier '...,.!," 'cr continuous ronituring, "!/7"
<br />for one day par ~: cc!:, "1/30" for one dam per month, "1/90" for one day per quertcr, err:.)
<br />9. F.n:cr "S~rp-Fe Tyr ," bath as "Sa,nr/z P:i ~lv::-s~;te;tr" (actual samp!c type escd during scn~to:irg period) aid as "Fenn;r
<br />2cjuirartr:rt," (e.g. Eotcr "Grab" fo- individual ss,rfp'e, "141,',"' far ?,-hour co.nposite, 'N/A" for coatiit'ous
<br />monitoring, etc,)
<br />10. SJher t~olations cf permit requirements arc reported, attach a brief explanation to dcscrba cap se and corective ac5ons
<br />to b;, tal:cn, aad refcrcace each violation by date.
<br />l 1. If"no discharge" occurs during monitoring period, enter "No Discharge" across fu~;n in place of data entry.
<br />12. Enter "Namr!l'ills of FrinciFal Exz.;utire O~t, zr" with "Sigtvttre of F~ i;r. ire! ~_cacuriv~ Off.;er aj Authorized
<br />Agent, ""Telephone Number,"and "Gate" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. Mote detailed instructions for use of [his Discharga hfottiroring tZport (Ctl.~ form may be obtained from O ace(s)
<br />specified in permit.
<br />Legal N®tiCe
<br />This report is requred by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report intthfully 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 year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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