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Paperwork Reduction Act Notice
<br />Public repotting 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 same major
<br />facilities, with a weighted average for major and minor facilities of 18 hours per response, including tune 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 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 instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permittzz Name/Mailing Address (and facility name/location, if different)," "Permit Number," and "Discharge
<br />Number' where indicated. (A separate forth 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 monitaring requirements of permit.
<br />5. Enter "Sunrple M~ a•urement"data for each parameter under "~iua!rrity" and ~alih~" as specified in permit 'Averagz" is
<br />normally arithmetic average (geometric average Ter tacterial parameters) of all sample measurements for each parameter
<br />obtained during ";,d%nitoring Period'; "i:4azinnua" and !Llininrrmr" are normally cxhcme high and low measurcmenU
<br />obtained curing 'Sh:r.%rsrbrg Pericd". (Dote to r inicipzls tvitlr secondan,~ treatmcn+ requirement: Cnter 30-day average
<br />of santplc measwcmcnts under "Average,"end enter maxunurn 7-day average o; sample meueremente obtained dur~g
<br />monitoring period under 'w:aximvm.")
<br />6. Entu "Pznnit R.:; niramaat"for each parameter unce; "~montity"and "~uafiry" as specified in pcrotit.
<br />7. Ccd=: "Art. Er" enter nunber of sample mess urcm _: ,Ching seniloring peiod that c::ceed maximum (~ nn/er mini-i~.an
<br />or 7-day average as appropriate) permit requirement fer each parameter. l f none, eater "0".
<br />8. Enter "Fr_y,uncy cjiLralysis" bath as "S_e.!pL ;.5. ~er•-a,;~z!f!" (actual frequency of sampling snd ana~ysis used dining
<br />i~.onitc.ivg p_:iod) and as "Pzrrrit R~gui,~r,!_n!"specifieC in pee .::. (e.g. L-nter "Cw;t,"for continuous monitoring, "1/7"
<br />for one day per v.~cek, "1/JO" for one day per monta, "1/90" for one day per quarter, etc.)
<br />9. ':ntcr "Sa.r,Fk Type"both as 'Samtla rrl~mura!rznt" (actual s~,nplc type used during monitoring period) and as "Permit
<br />Rag!eirzment," (e.g. Enter "Grah" for individual sanplc, "24H~" fo' 24-hour composite, "AI/A" for continuous
<br />monitoring, etc.)
<br />0. ~N!tere violations of permit requirements arc repor:c~~, mach a l:. ie`erplcnation w describe cause and corrective actions
<br />to be lateen, and reference each violation by date.
<br />11. If "no discharge" occurs during monito.ing period, en[c: "i"o Disci~argc" acTOSS farm i n plac._ of data enty.
<br />12. ntcr 'Nume/I'itle cj Prin_ipa! Pxe:utire !i~_a•" r;iih "S%g,ta!dr_ of Prin_iE ~! Er=aulivz O~czr of Aulhorizzd
<br />Agznt, ""Tefeplroz Nunhar,"and "Data"at bottom of form.
<br />13.:riail signrl Report to C.Trce(s) by date(s) specified in pe.;tril. Retai,t copy for your records.
<br />1'. ~Ror detailed inswctions for use of this Disch~rrgz ;.dcnitcrLro 2t ;n (Di~IF~ fo,-m may be obtained Gore Office(s)
<br />specified in permit.
<br />~~~21~ ~TD~rL~~
<br />This report is required by law (33 U.S.C. 1318; 40 C.P.R. 125.27). Failure to report or failure to report truthfully can result in
<br />civil penalties 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 ooe yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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