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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 10 hours as an
<br />average per response for some Honor 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, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permitter Nome/Mailing Address (and facility name/loca[ion, if different)," "Permit Number," and "Discharge
<br />Number" 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 in monitoring requirements of permit.
<br />5. Enter "Sample M asurement"data for each parameter under "Luarr!ity" and ~aliry" as specified in permit. "Average" is
<br />normally arithmetic average (geometric rvcrage for bacterial parameters) rf all sample measuements for each parameter
<br />obtained during "Monitoring !'cried'; "M,i~ir;umt" and rLfi;ri:;nmt" ara ^c,~nally extreme hig~r and low mcasurevcnts
<br />obtained during "Lf,nito,-in6 Period". (Note to munici?a!s with secondary trestmcnt requirement: ~ntcr 3C-day avera•
<br />of ;ample measurements under "Avsrag""and enter ma::imL~ 7-day ave ~gc of sample measurements obtainc3 d~!~ng
<br />monitoring period under "Ivlcuirrum. ")
<br />6. Eracr "Permit fia~uirement"for each paramc.er under "~uwrtity": rG "Qull(0~" as spcciGcd in permit.
<br />7, llnc'.es "P/o F..:" entr number of sample m_asLi _-TCn: durng monitor ^~ *:criod tar' a> creel m4cm ~m (snc"or minim.. ro
<br />ar 7- ay average as appropriate) permit rcquirc~acct far eacl; ?arameta . If none, oar "0".
<br />G. °ntcr "F.,-~u~s..y ofAn~l~sis" bath es "St„i•(~ ;. -.~ o~z(;r~.~"' (::c^.al fr:qucn~y of scnpli~,g and an:~ ;~si~ used d~.~rin;;
<br />monitoring period) and as "Permit 2quu-ar,:r!"spec;?ad in p. rrit. (c.~ '_'nter "_ .:~!," fn- continuous monitoring, "I/7"
<br />for one day par wee!c, "!/30"for one day per month, "//; 0"for one day por quarter, c~c.)
<br />°. Enter "Slmplz TjT~"both zs "Sample l.f ~ per; a;r.! !" (actual snmplc type used dur r, monitoring peried) arc: as ".~er,ait
<br />2.lui;emeat," (e.g. Entc,- "Gr~F" fnr individual eamph., "24l!~" for 24-hour com;osite, "P//A" `or continuous
<br />monitoring, etc.)
<br />] 0. Plhere violations of permit requircmert, rr~ reported, at.ach a brief cxnlanctinn to ccs.ribc cause and corrective actions
<br />to be taken, and reference each violation by date.
<br />11. if "no discharge" occurs during monito-ie~ pc;iod, cntcr'To II scharec" across fo, m in ; !ace of data carry.
<br />12. Enter "iJantelPitl~ of Principal F.r.>, etive G~xr" r,ah 'Si~a,~t.r:'r cf PriilCiTal lix8,::fliVe Cffi;;e:- of Aadr,r;crJ
<br />Agent, ""Telephonz Number,"and "Data" at bottom of farm.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retzin copy for your records.
<br />14. More detailed instructions for use of phis Dischn~,:;~ ;~~,;tito:i,tg R;nprt (!'d.T,J :c~,^ may be obtained from O^'c:,;~)
<br />specified in permit.
<br />~~ ~~ ~T~~.u~W
<br />This report is required by law (33 U.S.C. 131II; 40 C.F.R. 125.27). Failure to report or failure to report [ruthfu(ly can result 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 year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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