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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 !0 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. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Cffice of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />general Instructions
<br />1. if form has bees partially completed by preprinting, disregard instruction directed at entry of that information already
<br />Preprinted.
<br />2. Enter "Permiltee Name/Mailing Address (and facility name/loca[iov, if different)," " Permi! Number," and "Gischa7ge
<br />Number" where indicated. (A scpazate 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 "Sample A9ear:rrene,7t" data for each parameter under "Quantity" and Qr7a/it),"as specified in permit. 'Average"is
<br />oormally arithmetic average (geomchic average far bectcrial parameters) of all sample measurements for cash parameter
<br />oh`ained dw-ing "Monitorhng Fd:ioi"; ';'Garimri.7" and IvIInn;ra7n" are normally extrune high and low r-.easulemenis
<br />obtained during "i~;o7 itor-i,rd Pori%.l". (1TIO:c [o muruciprls with secondary tteatment rxuircracnt: 1=nter 3C-day arcra3_
<br />of sample measurements under "Awrlbt,"ard enter maximum 7-d:y avaagc of simple measar.ncnL obtained >ur:_;;
<br />monitoring period under "ivaximu7n. ")
<br />G. EniC~"Pe'ri7ll Regni.:meat"'CC C. ['~`ra7am::Ct'Pgd~i "~7'L•n(ilj,"rrd"~'1+,1%1)'"aS SpCC1,ICd in llCrml..
<br />7. Urar "h7•, F-" rn4r numLtr c`e_m;~'_ m.: serene r daring mon;t'•r~np, ,.;rod 7'n : c:.cccu na:dn:'m (ana'or min' .. r1
<br />or 7-.cy average as appn, riot,:) pen lit nqu4emert for cavil pc~ame:cr. Ifl;o;:e, en[_^r "0".
<br />0. ~nier "F;~;n~r~y of.';i'Jpcis" F.ct~l as "~.~,.7t 1, ;4_'.cs^rea7.•n!" sch~al fr~1u; ncy of s- nplirg end ana'ysis I~se~ r:u [ ~;,.
<br />monitoring pcrioc) and ns "r,.;,,uTc~;~~s,-~a air"spcci'icd in pcrruit. (a.g. !=ntcr "!'•,,u,"fnr continuous mcnilorir~, "//7"
<br />for one d:.y per /veer;, "1/30" 'c e~c rcy pc- month, "!/90" for one day per quarter, etc.)
<br />S. ante; "SJ7rple T,Fs"Loth as "S.nrf/d b; _c,nz„+a '" (cculat :.ample ty; :. used chi m~ monito'ng p_~icJ) ord a.. ,,.,ii
<br />lit;Jui7-~mr,l!," (c.g. :.nb: ":rr~l-" for irdividu^1 sample, '741f^" fcr 24-ha.•.r composite, "?r/~"' icr cr' ~~.~.ocs
<br />monitoring, etc.)
<br />]0. Pdhcru violaliuns of permit re~c`-emerts are reporter, Cu_cll a brief e:n'unarfan to C~ee,iSe cause end cu tc°:: - .. .. _n~
<br />to be rotten, and reference each violation by drtc.
<br />11. If "na discharge" ocer ~s during rnor`I~ ink period, en:tr''rdo C'scllarge" across foam L~ n~acc ofda'a ter' y.
<br />12. ~n[cr "Nar,7e/Tidz oj,^,in~iF~! E' •:.•tir~ G~~!__r" 1.`.Lh "Sisv7~p•;-,: rf /'rin_iF~l hrz.r7irc C~_ •. ., ...,
<br />Agrnl, ""Telepho;7e Numt'. ; " rnd 'Date" at bottom of form.
<br />13. Uail si~med Aehort to 0~: re(s) Ly ~cl ~s) spcci5cd i ~ pc..nit. Retain copy fur yo.~r recnrd,.
<br />Ih. i'lOiC dcL:ilad instructions for use o" C-is Gisd7zr~e h;Y:7ilSri,ia R.;',,t (D;v7RJ form msy be nbic, -'• f•; ,
<br />specified in permit. j~ ~tT
<br />~~ t~Q"~r l~,T~L'! o~~
<br />-J~~:~!i Vl:W
<br />This report is required by law (33 U.S.C. 13'.&; 40 C.P.R. 125.27). Pailwe to report or failure to report t7vthfully can rs~.';
<br />civil penalties not [o exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of vid.~.~~ ,
<br />or by imprisorunent for not more tlran one year, or both.
<br />EPA Form 3320-1 (Rev. 03199)
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