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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 hows as an average per response: for some major
<br />facilities, with a weighted average for major and minor facilities of 18 hows per response, including time for
<br />reviewing instructions, seazching existing data sowces, 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, 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 drrected at entry of that information already
<br />preprinted.
<br />2. Enter "Pern:ittee Name/ATailing Rddress (and facility name/location, if different)," "Hermit Ntmrter," and "Discharge
<br />Numher" where indicated. (A separate form is requrred for each discharge.)
<br />3. Enter dates beginning and editing "ir}onitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter"as specifed in monitoring requirements of permit.
<br />5. Enter "SurnF k M.a surement"data for each parameter under "Quontiry" and Quality" as specified in permit. Averaya" is
<br />normally ariihmetic average (geometric avcrage for bacterial parameters) of all sample meastrrements for each parameter
<br />obtained during "L3onitorin6 Fariod'; "i~~luzinnun" and rYlinimum" are normally extreme high and low measurements
<br />obtained dw-ing '; f%nihring Period". (D?ote to municipals with secondary treatment irquirement: Enicr 30-day average
<br />of sample ,ncasuremcnis under 'Avarage,"and enLr maximtun 7-day avcrage of sample meal ~rements obtained dw= .~
<br />monitoring period under "Maximum.")
<br />6. L-nt~_ ~ "Per,.ur R: j:!irrmeru"for each parameter und_; "Quantil)+" and "Qrrality" zs specified it permit.
<br />7. Uru_: "n'•, F_.." enter nwnber orsar~,~:c rreasuremeni during monitorng period t'1Li crcecd na:omum (a.~i'rr mini'nI7
<br />or 7-day ar~araoe as appropria:c) pe,-,ni[ rert<ircmert far each parameter. If none, etc- "9"
<br />8. °_nter "F~ e;rt -, ~y cjFna(ysis" h»r as "S.:,aF!e r,''su: ~ms:r" (actual frequency of sarnpicg r_rrd cnalysis used during
<br />monitoring pariad) antes "Fe„aii R jai: eur~rrr"specified in per,ni:. (c.g.:;nter "Corr'," far cunlinuous moniio.urg, "1/7"
<br />fur a-.e day per v.•e,'s, "!/30" for oac day per monlir, "}/90"for one uay per quarter, c:c
<br />S. ..°.nte: "Sa, !. Tj f ,;"colic zs "Sarr[,l. ~s_z;urern_at" (ac,ral sunp7c type used during monitoring period) ends "P:. mi[
<br />R,~a;;zrr~,u," (e.g. °ntec "Grit" for individual saap1c, "24H~" far 24-hoer ccr-rposiie, 'It'/,4" for continuous
<br />monitoring, etc.)
<br />10, ~::?"icr vie:~iione. o; perarit requirements are repor'ied, ctiaeb a brief explanation to desc,ibe cause atd corrective act~ans
<br />to be ta`.cen, and reFerencc each violation by date.
<br />11. ' f"r., discac.,ge" ozcurs during monitorng period, enter "Ara Discharge" across form ir, piace r f data entry.
<br />12. =n[c.' 'SV~:.rI/Ti:!' r~` P+irrciFal Ex~_vriv~ Cfji__r" Riih "Sibma!ura of Prin:;r}:il F_'.-eurlir» Gfficer of AerNroreed
<br />Figs::, ""T~: -Phone Nunt~r, "and "Gate" at bottom of form.
<br />13. ~ ~aC aigrc ;zpuG to C Tico(s) by date(s) specified in permit. Retain copy for your reco,ds.
<br />. • ;o, ~ de:~'_'cd instn~clions for use of thi; Cis;;horbe idariloring ReE;;7 (D,h7~ ;o-iil may be abtained Gam Office(s)
<br />specified in permit
<br />~e~a"3~ ~®tLJI~~
<br />This repori 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 year, or both.
<br />GPA Form 3320-1 (Rev. 03/99)
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