|
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, 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, disregard instruction directed at entry of that information akeady
<br />preprinted.
<br />2. Enter "Permittee NomzlMailing Address (and facility 7uune1location, if different)," " Parmit Numhar," and "Discharge
<br />Numbar" 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 "Parrnneter" as specified in monitoring requirements of permit.
<br />5. Enter "San7pla Maarurar,7ant"data for each parameter under "{hrantily" and QualiO~" as specified in petmit. 'Averaga" is
<br />normally arithmetic average (geometric zveragc for bacterial parameters) of all sample measurements for each parameter
<br />obtained during "/Y(aIIrO:'711~ r.'iTld"; 'SYla;;irreaa" and /YtinG:nnn" arc normally extreme high and low mcasurzmcnts
<br />obtained dwrng "1!f,,li[;: ing P,::i;_+". Tote to municipa~s with secondary treatment r:quircmcnt: ~ntc: 3~-day a;era~°
<br />of sampL measurements under "Avar~g ~, "and enter ma;imnm 7-day avc7age of ss.mple me~eurements obtained dor:7g
<br />monitoring period tinder "1/.ari;nu7;r. ")
<br />6. Lntcr 'Te7;.rit Ra~uil-:~::7e:7t"far eats parametc: under "~7rm7tiry" znd "Q77ofity"as specified in perrai±.
<br />7. Urrcr "N: E---" e~tcr rumba- r,f s^mplc rn: ~avc,r; ~t d ling mnn~to;ing prod that c•:cccd macimem (roc'or mini-: ~:
<br />or7-dry average as zppropriate) pem7it rcquircmcrt fcr each parameter. If none, enter "0".
<br />8. Enter "F.,:,m,:7..y ~.fAl7_~(ysis" both zs "S-~qr/a ,Lf_vsr.zr,::;;'" ~ach~al frc1cency of sampling and ara'ysis used du.-ing
<br />monitoing pered) and as "Pan,7it Rs;uireu:.;7~" rcci5..d in pa~nit. (ag. )inter "Coat,"for continuous monitoring, "1/7"
<br />fcr one day per wec!c, "//j0" for one day per month, "!/90" For one day per quarter, ere.)
<br />S. °nte- "Sm7,c/e Tj;ca" hoth as "SJ.i:r(, ,.~-•-•SN;"Yui1i 1" (eetual sample tyj.,; used during monitoring period) : nci as "Pe.7nir
<br />/ZSanL'aU7adt," ( '',ni~r "(,l'.~'u r err n r e
<br />c g for ~nwvidt~l ramplc, '74f/.. far 24-hour composite, N/A' .or continuous
<br />monitoring, etc.)
<br />'0. \•'/here v+acticns o; permit requirements r~e r= or'ed, att_ch a bricfexplaaation to dasnibe cauec and corrective actions
<br />to be ta!cen, and reference each violation by data.
<br />] 1. If "no discharge" cccurs curing mea°tc;ir~ period, e~Ycr "Tlo Discharge" across form in place of data e.at-y.
<br />12. Doter "Nal:7a/Tirl ~ off` "rinci/~/ .": r_utir; G~_~r" vrith ",°ior~kc•e cf Frinri~,:! Executivz G~ce~ oj` AtttSo.iz~d
<br />Age»t, ""Talaplane Nun71-~n, "and "Data" at bottom of form.
<br />] 3. \".ail signed peport to Office(s) Sy date(s) specified in permit. Retain copy for your records.
<br />14. Mor detailed insL~7ctions for use of this Dis~(u,~e ,L1,,7itoriat RF.: ~ (D;:1R) form may ba obtained from C'?^~(s)
<br />specified in permit
<br />1;J~~c111 ~T©UL~~
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R (25.27). Failure to report or failure to report truthfully can reault in
<br />civil penalties 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 yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
<br />
|