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]Paperw~rl•~ I~e~uction Act Notice
<br />?ublic 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 z ~*teightcd average for major and minor facilities of 18 hows 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, IrC 20460; and to the Office of Information and Regu]atory 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 "Pernritlee Name%Yroiling hddress (and facility name location, if different)," "Permit Ntmrher," and "Disch~rgr
<br />tVnmhsr' where indicated. (A separate form is requtred for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />S. Enta~ 'S~mple irL zsvrarnenP' data for each parameter under "quantity "and ~!ralil~ "as specified in permit "Ave, age" is
<br />ror:,tally arthroetic aveagc („eur'fctric average Co; bactsial parameters) of zll sample measurements for each parametzr
<br />obtaincl during "%~%cnitoring Fat;;,!"; ",Liaz+,mra" and ,Liuri.uu,u" are norntaCy esiramc high and ;utiv measure-revs
<br />oburir.ed d: irg ";:•~•.oirrin~ Pori^d" (Note 'n municipals v~ith secondary trcetmcnt requirement: triter 3C-day 2~e:age
<br />of sampic meastuements under "Av ~'-'n ~,"and rnter maximun 7-icy :.verge of sample menstrcm_nts obtained during
<br />monitoring period under ".biaximwn.")
<br />6. En'cr'S'.:rn;%:i~;r'i,-_ms.al"foreacnparamcterundcr"~~.nrtr:ti;"~!~c"~nra!it),"asspccificdinprrmi[.
<br />7. U:~dcr "i1'u ;.;;" er'e: nwnber u.-sampic -nee, arenert dining uwniturinb t•,cricd thr i _zcccd maz;mum (rndror rni„mum.
<br />or i-dcy aw~rge as appropriate) pert ii requirement for each parameter. IFrona, enter "0".
<br />f<. '=,r : "F'r_,:v.n ;, cf.•:,r_,itats" hour r, S.rm~l: iu_~t:n -;a • !" (uiu•~i f-uyucne~ of :,~mpling ar_i ana!~sis used duri ~g
<br />¢ri:ornopcrb::)andas"!'er,:~;:r~1,-i,_•:;:'r.•"spcdf:cc:in!~c.~r~t (e.~.~nc-".'•.,r!.•'fcrconCouoasmoniio!iny,"1/7"
<br />°or .,^..; day pa~~ wee::, "1/30":or occ lay per mount, "790"for uuc day par quarter, ac.)
<br />^>. =a.s 5.,,•f!= 7;F_"bath ~ "S_.,~ /: ,, .'_- ~:•••duu,.'(actua! swnp'c typo us;~l during : -.onilo!in~ period) anc us "/'_•:vui
<br />F.:yrb-,;,;t_,r, " (e.g. I'.rtcr "v,'~l-" rirr is"diviu~ti sample, ".?.it/,: For 24-hcu:~ ~_ornpcsitc, ';\7~." rot conti•teous
<br />monitoring, cic.)
<br />I0. !'saerc viol~fiuns of permit ,equ`:emeris arc rcpmtt%l, aftadt a brieFe;:plan;ion to %scribe cause and coex.ive actions
<br />to be taken, anc reference each violation by date.
<br />11. If"re dischar~c" a:ctvs d,:-trig mo~tilorng period, enter "No Gisdr::rge" across fora in pl cc of data enh-~.
<br />1=. cntc' "AS-n:,a'Tit/3 ,f lvin.;ipa! Exe„vtive G lr_::'" widt "Si~nrllnra aj Pr.n.-il _d E.ca_vlir+s Gf/ixr rj !u!:rte,! i_~l
<br />fiyov, ""Tek~F.•ona ithunha}"and 'Gate" at bottom of Forth.
<br />13...\5ai1 signed Repcrt to Office(s) by date(s) specified in pernut. Retain copy foryow rcroni,.
<br />'~.. wrote detailed inslnrctions for use of this Dic,:h~rge rLlonito,-ing 12eF:.r4 (G.Ylf~ form may be obtained from O°itcc(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 o: 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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