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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 minor facilities, to I10 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 instmction directed at entry of that information already
<br />preprinted.
<br />2. Ente- "Permittee Name/Mailing Address (and facility namellocation, if different)," "Permit Number," and "Discharge
<br />Number" where indicated. (A separate form is required for each dschazge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requvements of permit.
<br />5. Enter "Sample iLfe2suremuer"data for eacS parameter under "Quantity" and pitta/i7~" as specified in permit. "Avarogt" is
<br />normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter
<br />obtained during "M.,ritorhrg Period"; ",V,trinna,t" and Misr%„run" arc no„rtally cx'seme higl-. and low measuremcn~
<br />obtained during "ivfonitoring Perio.f". (Plot:: io municipals ~:,itli secoudan,~ treatment rrnuircment:~n.cr 30-day average
<br />of sample measurements under "Av,-rage,"end enter r1,.,cimem 7-:lay avcraga of srmple measurcmcnLs obtained d.~'_-g
<br />monitoring period under "Maximum. ")
<br />6. Enter "PL'17iii1 R,; uire,;re,,t"for cacti paramc+er und_ . "~ r.-rlih,~" c.t~? "Qrulir~," as specified in permit.
<br />7. U~:der "No F_.=" enter mtmber orsample mcsc~c-:^~ c~c -ing n~oniio,', ~ ; criod thrt e .ecad maximum (en~~cr min;:-.o~
<br />or 7-day average as appropriate) pemiii ruts:rc„ier.t fey each parameter. 1"~.one, enter "0"
<br />3. -nter "Fr:/uen_y cjArr~lysis" both ; s "^ 0.7,"!_ ;:, - -~-. e,a.,:'"'actuzl G.;uzacy of rumpling and analysis used G_ci~0
<br />mor.i:o ing period) and as "Fdrnti; Re;t~" -,, ., !" soec'fad in pc mi?. (.:. ~ &ntcr "^-,,,~, "Cur continuous monitoru,^, "1/7"
<br />Gor one dry per wee:c, "1/30" for one day pe- mon+h, "1190"for one dzy par qua,-ter, etc.) u
<br />9. ..°.ntcr "Sample Tjpe"bath as "San;~la i-Js ~s~~n~,;v~t '" (, etuat sample t;~pe used dc~'rg monitoring perod) an~1 as "^ ~.~r»
<br />R.rqu%re,n_;u," (e.g. Enter "GraF" for inwvidu:9 ~arnplc, "29:1~" for 24-hour composite, "N/A" `or con'i~u~u;
<br />monitoring, etc.)
<br />]0. \r/here violations of permit tceu'remcnts arc rupor~ed, r?tool, c br:efezp'mtal~nn Lo Ccsc~ib~ cause and cm-reuive ;._t'~as
<br />to be taken, and reference each violation by date.
<br />11. If"no discharge" occurs during monitoring pcrod, en _- "r:o T~'sdrr~r." across form vi p'a.c~ o. data entry.
<br />12. ='nter '7Jame/Title of Prin.ip:~l Faz,-utiia G~jt~a'" i.`~• '(;/,-,,i^.ae rf l'ruul.a! F.r__u!iv~ G~~:; cy'~:m;;•, -.
<br />Agan{ ""Teiephcaz Number, "and "Date" at bottom of fo: m.
<br />13. ?Mail signed Report to Offce(s) by 2atc(s) spccirec in p„nnit. Retain copy for your reeoris.
<br />14, AFOre detailed instructions for usa of this Gis~ha~br iv;o;,i!c,i,r; .Rsp .rt (t;iv:Fi~ nom may ba obtai:,.G Gen C"G~_; ~
<br />specified in permit.
<br />r,
<br />!~e~.uc'n.~_ 1 l li~~
<br />This report is required by law (33 U.S.C. 131 C; 40 C.F.P.. ]25.27). !'allure to report or failure to report truthfully can resell ;~
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violatiar,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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