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~°aperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of ] 0 hows 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, disregazd insWction directed at entry of that information ah•eady
<br />preprinted.
<br />2. Enter "Permittee Name/Mailing Address (and facility name location, if different)," "Permit Number," and "Discharge
<br />Number' where indicated. (A separate forth is required for each dschazge.)
<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. Evtcr "SamFle M_osuremznt"data for each parameter under "Qt(antity" and Quality" as specified im permit 'Average" is
<br />normally aritlunetic average (geometric avcrage for bacterial parameters) of all sample measurements for each pa~~rteter
<br />obtained during "rL;cnitoring Pzriod"; "d9-rzinnun" and ~Litnout!m" are normally extreme high and low measurements
<br />obta=ned during "i:~;snihrirrg Period". (Dote to mw~icipals with scccnd:ry treatment ;cquircmcnt: Enter 30-day average
<br />of sample measurements under "Average,"and enter maximum 7-day avcrage of sam,~lc measurements obtained dur:,g
<br />monitoring period under "fYiaximum.")
<br />5. Lrrte~• 'Pere;it fie;uire;nent"for each parameter render "Qr!anNty"and "Qt!ality"as specific:: in permit.
<br />7. lir'e_ ~ "N. F_ :" enter number of samp'c measurement during cionitming period Lu t e::cecd maximum (anynr mir~ - ..m
<br />or 7-day average as appropriate) pemtit requirement for each pa;amcier. If none, enter "0".
<br />8. Enter "F.s;,r-a~~• of~:naly;is" L~Ch as "S-o,(pL r'-L.zstlr.msr,!" (ac[u~l frequcvcy ufs-.unpling end analysis .sed during
<br />n.onit ~.ing period) and as "Pernit Re.7uira.nenl" spacificc: in rcrri'. (c.g. ~ntcr "~a~:,"for continuous monitoring, "1/7"
<br />for or.c day per e: ce'c, "1/30" for one day per monlS, "1/90" for one day per quarter, etc.)
<br />9. Sntcr "Su„-;~1: T,~E.z" Lath xs "S~srt ha ;r,.,stot'ner,tl" (actual srmp': type used durng monitoring ported) anc as "P.:nuil
<br />R~ytrirmenr," (e.g. enter "~nvt•" for individual sample, "141/"" for 24-hour composite, "N/A" fir continuous
<br />monitoring, etc.)
<br />10, h"i;.-u ~;o:atiuns o'parnit requirements are reported, : ttacb a brief c::planation io dcsc(ibe cause z id corrective act~cns
<br />to be taken, and reference each violation by date.
<br />1 l..': "ro discha.;;e" occers during monitoring period, enter "\o Discharge" across form in place of data entry.
<br />12. Enter "A(1,nz/77Jz of PrinciFa! 1:SdCe(tiVd G~'er" with "Sib~uture of Fri n;;i~,~l /;ceca!tive O~~~r ~f Authori~~,/
<br />Agdni, ""Tele/'h~ne Number, "and "Date" at bottom of form.
<br />' 3. b.iai: signed nepof~ le CfGcc(s) by dale(s) spxified in petnut. Retain copy for your records.
<br />"or: ~e:~i'ed irstructions for use of this Dischorg~ i.9onitcring R•E~!-t (Did7i~ fc.Tr may be obla~ncd from Cfficc(s)
<br />specifed in permit.
<br />
<br />This report is requred by law (33 U.S.C. I3I8; 40 C.F.A. 125.27). Fai[urc to report or failure [o report truthfully can result in
<br />civil pemalties 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 />''??A Form 3320-1 (Rev. 03/99)
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