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Paperwork Iteda~ction 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 />I. If form has been partially completed by preprinting, disregazd instruction directed at entry of that information aUeady
<br />preprinted.
<br />2. Enter "Permittez Name/Moiling Address (and facility name location, if different)," " Permi! Number," and "Ducharga
<br />Nuntb~r" 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 "Paramaler" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Measurz»tent"data for each parameter under "Quantity" and Qualify"as specified in permit. "Avzroga" is
<br />normally a ithmetic average (geometric average for bacterial pammetcrs) of all sample measurements for each parameter
<br />obtained during ".Llsnitoring Period'; "~Llasirntm?" and biuti;;uun" azc no: nally cztrcme hig;t and ]ow measurmerts
<br />obtained during "i„ .nitnring PerioJ". (Note to municipals with secondary treatment rquircmcnY: En[cr 30-day average
<br />of sample me.s~uements under "Average,"and enter ma:imcm 7-day average oCs~c:ple measurements obtained during
<br />monitoring period under "Maxir,:un.")
<br />v. Enter"P.:%%:ritlt~ui;.+.,ant"for eachpazameterundcr"Quou(ir~"rind"Qua/ity"as specified inp.,~r~it.
<br />7. Ur:'cr "P't F,:'" ente- nu nbo- of sample meesor~ re,i`. during monitoring ,period L'tr? c-ccec; mc:.:.., m (uic'/or mini~::m
<br />c. 7-:'iy avc-aga as :,ppropriate) permit rcc;uiremeet for each naremeter. If none, ~ acr "q".
<br />g. ~'nter "I;-e./orr: ~~ of Analysis" both as ".S_r,+_r/~ ,V, .rv~r=,;t•, ~" ,cctus! fregt^ne;~ of s: npli~g cvd analysis used during
<br />moni'.c~ng period) and as "Per~+i! Re~nir~u.-;u" rpecificd in pecnit. (eg. 'into; "_ .. r,"for continuous monitoring, "1/7"
<br />for one nay pe; wee'.c, "I/30" for one day per month, "!/90" for ooe day per grmrter, e.c.)
<br />S. Cnter "S,?nr(~ Tyra"bath as "S.avtrla U~osnrd;,t~r!" (cetual sample typo 4scd d~.:' •~ -mnitorinL ptricd) an:: as "~an,eit
<br />2~eitatneu(," (c.g. Enter "Grab" for individual sample, "2-TitC" fo: 24-hnc- r;n.J,'ie, "1'.'/A" for continuous
<br />monitoring, etc.)
<br />'0. \.'here violrtions of pcrr*tit rege~-ec+ents c,-e rc~.orted, attach a b.-ief e,:planat~on to d°s~~i.ta cauc° r nd corcc~ ve actions
<br />to be taken, and reference each violation by date.
<br />1 t. [f "no discharge" occur during mor'tcring period, cnt _r "A'o Ctschar;;e" cans fo~n in n!: cc r,f dc':. r'y.
<br />12. Enter "Nmn~/Titl~ of °rincipal F..rt.:alivs Gf}i.rr" a'th "Sib,;a'.a~~ ,,J f, 'n,~:;-_ ~...,,•d~.v :~~~: cf AtuS;:c:1
<br />Agent, ""Talephare Num!•er, "and "Dale"at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in pcmvt. P.otain copy for yo: :; cn c,:.
<br />14. Mori detailed instructions for use of :his Gis~lur~~ i~f;,ti!o.~ing Rc;;t ("'.'R) '~,-n ,r-.y ',t: c~ria_~~ Fon C"'ces;
<br />specified in permit.
<br />This report is required by law (33 U.S.C. 1318; 40 CF.R. 125.27). Failure [o report or''ailure to report truthfully can rzsult in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties net to exceed $25,000 per nay 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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