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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. Enviromnental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 2046C; and to the Office of Information and Regulatory Affairs, Office ol'Management and
<br />Budget, Washington, DC 20503.
<br />Gene~°~1 Instructions
<br />1. [f form has been partially completed by preprinting, disregazd instruction directed at entry of teat information already
<br />preprinted.
<br />2. Enter "Per-mittee Name/1Lfaifirrg Address (and facility name/location, if different)," "Permit Number," and "Discharge
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monirorin3 Peri-,d"covered by form where indicated.
<br />4. Enter each "Parama~er" as specified in monitoring requirements of permit.
<br />5. Enter "Sampfe Mzasurertent"data for each parameter under "~umttify" and Quality'" as specified in permit "AvaraAe" is
<br />normally a*ithmetic average (geometric average for bacterial parameters) of all sample moasurcments for each parameter
<br />obtained during "Mutitoring P~ricd"; "hfuiuu:cr" and Mini,nunt" arc normally extreme high and low measuremcn~s
<br />obtained during "L1.nh;rirr~ Rri~,J". ('Vote to m::^ici tits with secondar,• treatment rqutrement: Enter 30-day avcrag_
<br />of sample measurements under ",1v •r,r~a,"and enter maximum 7-day average o` sample mersarcments obtained during
<br />monitoring period under "Maxinnart.")
<br />G. F.ntcr "f'diT,rlt l~auir~ntent" for cacti parameter under "Quuttiq~"and "~u.lity" as specified it prmtit.
<br />7. Urdcr "T.'~. °:" c .,r mrmb.:r o`samplc mersum-rnt th.ring moni;n=ng ;eriod uta, cscccd maximum (anJor mini;rr~n
<br />or 7-gay a~-crage as appropriate) permit requircr acct fcr cadt parometer. 1: none, c~tcr "0".
<br />Z. ?nter "F,-~~tr~ n_y cf ~:naJysia" halt rs ".S.r;n~ J..1 . ,,,!,~,,,; ~,; •'• ~atnral fregr_rc;• rf santpli^g and ar,atysis used during;
<br />monitoingperiod) and ac "Pzr~nit 2•;uir~n;.-c'" c~(;ed in pcrr,tit. (e.g. °_nt.•r'.^.-.,it,"for continuous monitorin„ "//7"
<br />for cnc day per wee!:, "1/30" for onr. day per month, "1/90" fo[ one day per quarter, etc.)
<br />S. °nter "Srnl:J~• Type"both zs "R1nrrL M~ -~ar.amant" (actual sample ty; c used during tinnitor,-.g p°ricd) and as "f'ernit
<br />R~1ui.smzat," lag. Enter "1rlF" for individur' sample, "1~'lr~" .or 2~:-h r.tr covposite, "N/A" for continuous
<br />monitoring, etc.)
<br />' 0. \'Jhere violations of permit requirements r*r rq.n:•~.~1, r.C•: c'.~ a hicf r:planatian co describe cause and correcSve actions
<br />to be taken, and reference each violation by date.
<br />11. if "no d+scharge" occurs during mo: te~ino p~^:ed, enter "~'n Discharge" across form in place of data er ~*y.
<br />12. 'inter "Naare/Tit(r cj ~"r-in~ipal T;r~_ati _ ~-;'p _," trait 'Sib,r~~,rz of /'rin:•i~a Ex~~utive Gffi.;ar of Au!Jtcriz~d
<br />Agent, ""Telephone Number, "and "Gate " at bottom of form.
<br />] 3. Mail signed Report to Office(s) by dale(s) specific: in permit. Retain copy for your records.
<br />]4. More detailed instructions for use of this P_'~ch_~, ~a .1i;;ril:r?:rg Rzr,.7 (L';..7~ fern may be obtained from Ci7icc(s)
<br />specified in permit J
<br />n -,- u
<br />This report is required by law (33 U.S.C. 1310; 40 .C.''.IL 125.27). Failure to report or failure to report truthfiilly can result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $21,000 per day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Eorm 3320-1 (Rev. 03/99)
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