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Paperwork Reduction Act Notice
<br />Public reporting burden for This :olfaction of information is estimated W vary from a range of 10 hours as ao
<br />average per response for some minor facilities, [0 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining [he data needed, and completing and
<br />reviewing the collection of information. Send comments regazding the burden estimate or any other aspect of
<br />this collection of information, mcluding suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Envirommeotal Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1'. If form has been parially completed by preprinting, disregard instructions directed a[ entry of that information
<br />already preprinted.
<br />2. Enter 'Permittee ,Vame/1Lladrng Address (and facility name/lopuon, if di6erent)," "Permit h'unrber," and
<br />"pischarge Number" where indicated. (A separate Corm is required for each discharge.)
<br />3. Enter dates beginning and ending ':4fonttoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements oCpermi[.
<br />5. $nter "S'ample Mea.;urernent" data for each parameter under "Quomity" and "Quality" in units specified in permit.
<br />".4veroge" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />Cor each parameter obtained during ",lonitoring Period'; ",tlarimwn" and ".A~linimum" are normally extreme high
<br />and lou measurements obtained dunng ".t9mutoring Perod." (Note to municipals w~lh secondary trea:rtrent
<br />requirement Enter ?0-day avuage of sample measurements under "Average," and enter maximum 7day average
<br />of sample measurements oblain:d during monitoring period under "Maximum.')
<br />6. Enter "Permit Regmrement" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under ".No Fx" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency ojAnalysis" both :s "Sample rtifeasfrnnenr" (actual frequency of sampling and anal}'sis used
<br />during monitoring period) and as "Pe -mil Requirement" specified in permit. (e.g., Enter "Coot," for continuous
<br />monitoring, "//7" for one day p:r week. "1/30" for one day per month, "1~9G" for one day per quarter, etc.)
<br />9. Enter "Sample Type" both as "Sample ,4leasurement" (actual sample type used during monitoring period) and as
<br />"Permit Requtrernerrr," (e.g., inter "Grcb" for individual sample, "11/fC' for 24-hour composite, ".h%:4" for
<br />rnntinuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by daft.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in peace of data entry.
<br />12. Enter "Name./Title ojPrincipai Executite Officer" with "Signature ojPrincipa! Executive Officer ojAutharized
<br />Agent," "Telephone ,Number," and "Date" a[ bottom of form.
<br />- 13. Mail signed Report to Office(s) by datets) specified itt permit. Retain copy for your records.
<br />14. More detailed instruGions for use of lh~Discharye Monitoring Report (DtifRJ form may be obtained from Office(s)
<br />specified in petrnit.
<br />Legal Notice
<br />'I'bis report is required by Law (33 U.S.C. 1318; 40 C.F.R. 125.?r?J: Failufe to report or failure to report truthfully can
<br />resat[ in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />- of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
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