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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 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, disregazd instruction directed at entry of that infortna[ion already
<br />preprinted.
<br />2. Enter "Pernrittee Name%Lloiling Address (and facility name location, if different)," "Permit NumF.er," and "Discharge
<br />Numrsr" where indicated. (A separate form is required for each dschazge.)
<br />3. Enter dates beginning and editing "Ivloniroring Period" covered by fotm where indicated.
<br />4. Enter each 'Parameter" as specified in monitoring requirements of permit.
<br />5. Enter 'Sample dlzasurenrent"data for each parameter under "'~uantiry"and Qualify" as specified. in permit. 'Average" is
<br />normally arithmetic average (geometric average fcr bxterial paranxlers) of aL sample measurements for each parameter
<br />obtained during ",Noairoring Pe;iod'; "i-hsirmrn" and rYlinimrnn" aze normally extreme high and low mcasw~mcn's
<br />obtained during "i.~l;nit;ring Peri,.+". (D'cte tv mu,n~cipals wit;7 secondzry treatment revvirement: Enter 30-day average
<br />of sample measuremn~ts under: "Avarag-,"and cltcr , ;:-;imam 7-day avcr~gc of sample meal rrements obtained dung
<br />monitoring period under "i/axirrum.")
<br />6. Enter "Pennii Rewirrrnenl" for cacti prsam~tcr uni :. "Qe~nNrp"and "Qnrality"as specited in permit.
<br />7. lir.d_ "R'o F'" enter r.u abet of samp:.; me-sw~o~r.r.t ::_- ~ r..ari.oring pcr'od f~.a c :ceed maximcm (r~~d/or mini o,m
<br />or 7-dry av~,-age as ay,propriatc) p~:mi! rcc_ui:e, iert A.r each par:~neter. If none, cater "0".
<br />3. L-nter "F,~:.ie..:_y cf /.,ulysis" b~lir as "S rr!.:._.%.+r. _rsu%" (actual frcgarncy of szmpling and analysis used durin^
<br />nonilcing rcriod) and as'Trr,.:ir 27: r;. _.:r.:,v1"sl.ac ~cd in rr,,':. (c.g. Ea:er "Coal,"forcontinuoas monitcring, "//7"
<br />for oce day per w. ee's, "1/30" for cne day p;:.- moa::r, "I/90"for one day per quarter, cte.)
<br />9. =ate; "Smrlle Type" bath u 'Sa,aNls : ,_au,~_urrn!" (~ctucl sample type used durir,", monitoring period) and as "Ptnni[
<br />Peluir•„msnt," (c.g. Enter "Groh" for i~dividu:d s:.,plc, '7,•'/f~" for 24-hoc campos$c, "\r/A" for continuous
<br />monitoring, etc.)
<br />10. 'r,"acre vio!utions of pewit !-er,uiremena ~~ repo: cd, u,ach e b.-;c"explanation io describe cause znd corrective actions
<br />to be ta:cen, znd reference each violation by dare.
<br />11. li "no discbu-ge" occurs during monitoring pc.iod, entry'?Qo Discly rge" acoss form in p'acc of ca[a entry.
<br />12. F.n[er 'SUoru/Tide of PrinciFa? Eee_v[ive Gffixr" ~r1r "S%on4~Gne of Prin_iFu/ Exe,,utive Gffio~r of Au[ho;izacl
<br />Agz;rt, ""Telepircnz Nu,nha•,"and "Gertz"at boaom of form.
<br />13.:~3ai1 :igned'tcpoil to C~„ce(s) by uate(s) specified in p[,nnii. Retain copy for your records.
<br />l~'. ?Coro detzilcd instructions for use of lids Gischlree ;il,.,it~, ino 2psrt (DivtR~ fern may be obtained from Office(s)
<br />specified in permit.
<br />~~~~~ ~~©yll~'~
<br />This report is requred by law (33 U.S.C. 1318; 40 C.F.R. 125.2")7. Failure to report or failure to report truthfiilly 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 yeaz, or both.
<br />EPA For® 3320-1 (Rev. 03/99)
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