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Paperwork Reduction Act Notice
<br />Public reporting burden for this co]lection 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 inst-uctions, 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 already
<br />preprinted.
<br />2. Enter "Permittee Name/Mailing Address (and facility name location, if different);' "Permit hirmber," and "Cischargz
<br />Numbzr" 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 i^ monitoring requirements ofpermit.
<br />5. Enter "Sample li9easuremznt" data for each parameter under "~ua,rtity" and Qualit}'" as specified in permit. "A v:. agz" is
<br />normally aridunetic avc,-age (geometic avcmgc for bac'crial parameters) of all sample measurements for each pararncte,
<br />obtiined during "rV,oaiY,r6ra ,,^-eri;.i'; "dflc%,nr,a" and Min%;;:um" arc nornally extreme hi ;;: and low measurements
<br />obained du-iag "Eionitoring!'a•i•..l". Tlote to municipals ~.+itii secoodruy treatment ,s;u;rcmcat: _.niL,' 3C-day averr~r
<br />of sample mcasuremer,ts under "Avg. _~La,"and e fret ma;:im~m 7-dry avcrzge of samiae mccs. ramcnt. obtr nc5 d~~ ~ g
<br />monitoring period under "1oaximum.")
<br />6. P:ntc,r "Fzr,.-it R_; rtir:arart" "or each parameter under "~v.~nliq~" a,ut "~erality"as specified in p,rr^it.
<br />7. Under "IJo,^:" cchr runbxr of sa.:r~'c meeslrene~~ d~.ing mnni(ora; r.°=~d t: ~. cecd mc::i,: ~ (vn./r,- m'..' - _
<br />or 7-day outrage as a~.prr,;;~icle) pcr~ pit rc ;wire:;~e: ;for _ach pammcter. I~none, e:~t ~- "0"
<br />8. voter "I•',~~rren~y y`A;vl~tc%s" h~P~ : ; ",S'_~,:;, ',... - ~i.. ~,,m•.r" (sch~a "rrtu_ney of r~ -rp'i •~ cud an .'yes rscd ~
<br />monitaingperiod) r-.d rs "Fr,;,~ r 2;:~„_ :;:rrr"sacd!icd in pr~mi;. (ag. outer "Con',"fnrcontinucns monitoring, ";; 7"
<br />far one day , er wee'.c, "1/30" fo- cur. day pe- monLr, "1/90" for one day pa quarter, etc.)
<br />9. '? ricr "c.,rrph: T•,r~" hoih as ' . ~vr-!~ .' i •~~nr'.o •, ;^ (zctunl snmp;c tyr i ced dur n~ monitoring }'~. i;,7; ; .r.
<br />R:lui.•~mar+,° (e.g ;=n:_: "Gr.F" fur individual e.mplr, '74H~" for 2•;-hour con-,po~~tc, "i,r/,," for c: ~i~_;
<br />monitoring, etc.)
<br />10, lVhert v'olttior, oCpe~m$ .et;c~rer.ir:'~ arc rpor e:', rdtcch a b.iefe::p'.aar''nn to i ar iSe ca~~se c id c ~ . ~ ':• e . , - ,
<br />to be ta!cen, and reference each violation by date.
<br />11. If"no disc:tar;;c" acct s during ,non'to. in, pe: cd, on[-r "'.~o C'scharge" across fc n ~ i p~acc n'd:'- rr':,
<br />12. °nter '%darna/Tilr: off` ^,-i,ci~al E.r•_utive cfr:.,~" wiut "Siwrlhc•t rf 1'rin,;r~1t ,..d_zr~P.t ITT ~-.- ~;" ~ ~ .
<br />Agent, ""Telephcnz IJu~nlw, "and "Cara" at bottom of form.
<br />13. Yail signed Rc;;an to C""cc(s) by d:!tc(s) specified in pcnnil. Rct<1in copy for yoc~ xco~is.
<br />1~. I!^ore detailed instnrclions for vs~ c.` E,is Cis:;/ra;~;= +Lt-,;,ir,riag R ;r ~,,; (C;1~ "~~ n n~ ~ b~ u`_ '~ r ° . -- : ;
<br />specified in permit. ~ ~ T
<br />T~~~~ I! ~V ~ ~L~~'
<br />Tbis report is reouired by law (33 U.S.C. 1318; 40 C.F.R. 125.2'n. Failure to report or failure to report truthfully can rc.: ~ ~ r
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penzlties not to exceed $25,000 per day of vie',• -ic „
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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