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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, seazching 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, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Eoter "Pernlittee Name/Moiling Address (and facility name/location, if different)," "Permit Number," and "Discharge
<br />Nunlbzr" where indicated. (A separate form is required 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 />5. Enter "Solar z Mezsurzmznt"data for each parameter under "~uantiry"and (iualit;~" es specified in permit. "Avzrage" is
<br />normally arithmetic average (geometric average for bacterial parameters) of all sa~np'e measurements for each parameter
<br />obtained dung "tr;wlilnring Period'; 'SLlazinrl,l" and iv/iai::uml" ar normally eztrcme high and ]ow measurcmentc
<br />ob';lined doing '?/,o11iY,ring Pelz,1". (Idete to munici; _'s ":~itS secondar;~ trcatmcit rquirerttent: Enter 30-day a~cra~c
<br />of sample measurements under 'Averagz,"and enter ~na:eimr n 7-aay av:.ragc of sr nple measurements obtained d:.rmg
<br />monitoring period under "Maxirlun.")
<br />u. F.ntcr 'Tere~it Rr?uirzrnz;u"for each pazameter order "zu~niih~" c.;d "~ualiry" as specified in pemilt.
<br />7. Urd~r "T.1-. F;:" c-t,.- nembcr of sample mws!re-•~c-~' during noni,enng :ericd tit::! c~=ceed maxiraln (snc'/ur r,.inilr.,.~.~
<br />or 7-day average as appropriate) permit requirement for eact• parametc-. lfnone, c' r "0".
<br />f.. °nter "F, yezll,.y Gf .'.rulysis" both l+s "S ~rrcfe ;.fticly al,hrt" (actucl frequency of scrupling auL analysis used during
<br />momtorng period) and as "Permit R>q;fi;zm'rr!" s; c:, icd m p: -n rt. (o.b. 'tenter "Celt," inr confnuouti momtonng, "//7"
<br />,`or cne day per wee:, "1/30" for one day per month, "1/90" fcr ono day pot quarter, etc.)
<br />9. °_nter "S~nlrl' T~Fe"both as "SanlPlr Lf--•wl.~:,ur,!" (rctual semplc q;~c used durir~ mnnitorng petted) and as "^_,,,lit
<br />2.l:rirznlerrt," (;..g. Enter "Grab" for individual samplr., "24H~" for 2S-how r;,mpnsite, 'SV/A" `or continuous
<br />monitoring, etc.)
<br />' 0. ~`.~rcre violations of permit requirements are repcr`cd, ctt~cn a brief explanaron to descriic cause aid corrective actions
<br />to be takers and reference each violation by date.
<br />1 1. •.f"na discharge" occu-s during monitoring pc-icd, cnt:r "No C~scharge" across fcrm in p!acc of data entry.
<br />12. Enter "Rtalnz%Titlz Gf 1°rincir'al Tx__>~uliva Gear" v.~~th ':Sim;IJl~~1 ~ Gf rrulci; ~! Fx~.:elivz C~~~er Gf Au4SGri?sd
<br />!,gent, ""Tzlaphoae Number,"and "Date" a[ bottom of form.
<br />13. \4ail signed Report to Oft9ce(s) by date(s) specified in permit. Retain espy far yaw- records.
<br />1~. Moro detailed instructions for use of this Dischargz r'/.•,aitc;i:rs F.;Ts;t (D;.,Te) fon;l mry be obtained from Cu ce(s)
<br />specified in permit.
<br />_.
<br />~~~A ~~ ~ ~~~?
<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 peoal[ies not to exceed $10,000 per day of violation; or in criminal penalties not [o 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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