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, 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 "Pernriltee Nante/Mailing Adyress (and facility name/locarion, if ditl'erent)," "Permit Numher," and "Gisch~rge
<br />Nunrbar" where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Paronreter" as specified i^ monitoring requirements of permit.
<br />5. Enter 'Sample ,LLasurernent"data for each pzrameter under "Quonti.ry," and i roll;r"as specified in permit. "dva•aga"is
<br />no,mally arithmetic avenge (g.umeLic average for bac'~rial paramcte~s) of all sampbs measurements for each panmcter
<br />ot'aincd during, "Jv,'%nif•:ring f8ri%d"; "iofarinttrt" and hfiai,num" arc normal', ex+~~me hive and lov: measu emenls
<br />obtained dazng ",'6ouito:-iub /'rricd". (D!ote [o municipals r:ihr secondar,• trca~cn; o:luiremcnt: °_ntcr 30-day avera„e
<br />oCszmpl_ m-asureme its under "dual ~e,:,"snd enter maximum 7-day av~~age cfs: plc meas:rzments obta;ned d,~:.-,
<br />monitoring period under "tl.aximum.")
<br />6. 3*.:er"Aa,;.:itR'.;nira„itnr""orea~iparrmeterundc.r"~r•ontity"rnc "~ia~/iq,"assli~:i~iedin;rrri~.
<br />7. J-..' "i~r• r." ~,t_: nembcr c"s1-nplc mcrs.~'crc-:' during monitor~o~ ._ri~d G,~' c~ :.:c~ -,; zim~ "i (~rt~/or nin~ . .r
<br />or 7=_sy average as appropiate; permit requirement for each pru~mcter. li ncnz, : rt_- "9".
<br />II. "der "F, ,;,,,,,~:y of dn~l;•sis" both as "S ar;rla !.4 _s~~ ar,i_,+t" (arlual fr~gc^ncy c. ~ apling and analysis used Burin;;
<br />ru•ilrring period) ar~J as "Fan,i.`i R:;~r,'ra„~_,,~"s^c_'ficd in ;c:vrit. (e.g. '_-ntcr "„•,:v,"fnr can Cuuou monitoring, "1/7"
<br />;ur eu. dt y per vec':, "1/30" for one day ne- montir, '290" fer one dcy per quarter, e'.c.)
<br />9. °..rt.:; "fin; fla T~g~ "both as "S~n.,rla I faarerar.t r,rt" (actual sample typ: usca Burr •~ a^o:rito~in~ Fcrird) and as "_°~~ ~,t4
<br />!L•liri.r,n_,;t," (e.g. L-ntc,, "Ur,.,F" for individual sample, "?4/IG" for 24-h;;ur ca~r,po•ilc, '?'/A" fer car,linuo,is
<br />monitoring, etc.)
<br />'.^_. \'frc,a v;ol~tior; uCpermit -cqui-emerts arc reporied, zu~ch :. brief c~p!auat;on to c _::ribe eees_ r^.d cn-re::i~ e actors
<br />to be tatter, and reference each violation by date.
<br />1 ]. `.. '.:o a .c:r_rg~_" occu s during mon tairo period, en:_r'?Io f;ischarge" across term ` i ,:'~e, cf Baia t, •hy.
<br />12. -u!^r ";d~,u:P~(k rjF,•in_ipal tsr,zrtil~a Gear' with "Sigultsr t:JPrin,i/a! ;ir_.~u7~.~e G~_••,- cf r.'c~ho.'~=zJ
<br />~'g_ct, ""Telzp;n,ta NuuiPa•,"and "Dat,z" at bottom of form.
<br />' 3. .. '. ; ~ ed ^. •~o.t [o C~ ;ee(s) by date(s) specified is permit. Retain copy for yon rear's.
<br />... ~ .: Ca'tal'rdL ILSL'LCLiUnS fni CSC Of tl?;S DLChar'g_ lt'i'n lll~i/!no R;;'/iri (T:iva~l fJ^J n1:.y u9 ObtLl'. i']li ffC T, ::~ 1C-~5)
<br />specified in permit.
<br />This ;-eport is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or fai]ure to report truthfully can resat: in
<br />civil pc~altcs no[ to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violative,
<br />or by imprisonment for not more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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