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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 Protectio^ Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office of Information and Regulatory Affatrs, 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 [hat information already
<br />preprinted.
<br />2. Enter "Permittee Nome/Moiling Address (and facility name location, if different);' "Permit Number," and "Discharge
<br />Numbar" 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 "Sanrpta Ivfaasurerrent"dara for each parameter under "Quantity" and Qrrolip•" as specified Ln permit. "Average" is
<br />normally aritlunetic average (geometric average for bacterial parameters) of all sample measurements for each parameter
<br />obtained during "Iv;,nit~ring Period'; "Mazirurrr" and ~ni,.nrm" are normally e>;trcmc high and low measurements
<br />obtained during ";donitoring Pa is_f". (TQote to municipals with secondary 7eatment requirement: inter 30-day a~: e adz
<br />of sample measurements under ~iv.~ aea,"and enter maximum 7-day average of s~raple measircmen[s obtained during
<br />monitoring period under "Maximum.")
<br />6. Ente; "Pen, ii R:;ui,•sr::e,r1"for each parameter under "Qua,uiry" a'd "Quality" as specified in p:,rmit
<br />7. Ur~'cr "T+-. ;iz" cote number n~sample m;^srreTent during monitornp, ; ; rind tn. ~ c~ cecd maxim..m (: ncJ~r mini.r.:m
<br />or 7-~ y avcrnga as appropriate) permit rcqui,-cmcnt for each parmeter. [f none, enter "0".
<br />>3. °nter "Frrle.a_y cf: »_~lysis" both rs "Smr~h ?„'-~s~~n,n,r,r+" (acn_al fire, ucney of srmpl~n3 and an:~';sis vseri during
<br />monitorng period) and as "Per,urt 2, +~re,ndnr" spcc;ficc: in permit. (e.g.'.:ntcr "Co•r-,"for coot+nunus mcn~~o,-ira, "!/7"
<br />for ono dz.y per wed:, "1/30" for one day per monGr, "1/70" fcr one day per quarter, cie )
<br />q. Hater "Ssn;cla T}Fz" both as "SamTle lif~asu,-:ment" (~clual samplu t;+n_ usc3 dur'r~ .~oaitorin,", pcricd) znd as "Pe;,nit
<br />R;.7re6~zns;u," (c.g. Hater ".1raF" for individual svnplq "14NC" for 24-hcur composite, 'S//A" for ew:iinuous
<br />monitoring, etc.)
<br />10. Flhere violcticns of permit ,-equirements are rci:orted, attach a bicf explanat;cn to 2cs:ribe cause aad cocec5va actons
<br />to be ta:cen, and reference each violation by date.
<br />1 1. If "no discharge" eccurc during moni;arin, perod, enter "\o D;scharl;c" across form in nlnce of de+c e '.y.
<br />12. Enter "Nm;re/Titla cf '~•ir:ci~al Rz~.ulirt G~~~r" with "Sign/+~ra ojI'rin,ica! :_acutive C,f;a~• oj'Av!4:rlrut
<br />Agent, ""Tzlephona Numbar, "and 'Gate" at bottom of form.
<br />13. Mai] signed reports to Of ice(s) by date(s) specified in permit. Retain copy For yoc- ron-~ s.
<br />14. Mor detailed instructions for use of this Tis~harb.: ELI-~nitcri;rg .Raf~,rt (C~1eTe) run r-a, h= nL~ i~-.i f-em C''r(s;
<br />specified in permit.
<br />~.~~~.~ ~7~~~~
<br />This report is required by law (33 U.S.C. 131 S; 40 C.F.R. 125.27). Failure to report or failure to report truthfully 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 imprisommemt for not more tham ome yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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