|
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 ttn average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing; the collection of information. Scn,i ,.omments regarding the burden estimate or any other aspect of
<br />this coll:ction of intoru~ation, including suggestions for rrducing this burden, to Chief, ]reformation Policy
<br />Branch, F'M-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; end to the
<br />Office of Information and Regulawry Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If fnrrc has t+con partially complued by prepr,ntirg, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. (inter "Penniaee r.'ame/.llniling Addre.rs (and facilth• name/loptior iC di6erert)," "Permit h'wnber," and
<br />"Ciscncrge .Number" •: heee indicated. (F. ~cparate Term is required Por ach discharge )
<br />3. Cntcr dates b~ginnin,; ;red ending ';1fum;oring Pertod" covered by form where indicated.
<br />4. Enter each''Parurnerer" as speetfed in r.:cuitoring rcquiremznts of perntit.
<br />5. ~rter "Carrp:e,ltrn , remenr" Jan for each ~;:,a,netc urdcr "Ouartity" and "Quality" in units specified in permit.
<br />"•'~ : ; :gr" is rorrnail:~ grit."~ ~.•~;~ a•.:,;;~„c (g:. metre average 1~ar bacterial paramelerst of all sample measurements
<br />for r^ch parmcter o;,iairer' daring ",L;,a;'.,::., Pr •atd". ",lfaxinmtn" and "dfininmm" arc normally eaueme high
<br />and ILK r•,~.,urrrents ofiair,r^ duri~:g "'tonrtoru:g Perrrd." (Note to municipals with secondary treatment
<br />~equitz:nent: F...•^- l9-.'.a aver.°ce of s;mt; i,. mea•,•; rment~ tmdr. "Arc rage," ar,d enter maximum 7~ay average
<br />ofsatnple nt~asurem~ats cbtaincd !ur'ry :nor.itor.'ng period undo; "a/arimun~.'j
<br />,.. [.nter "l'ermr r7eq•,rreme:rt" Cw each ; ar:~,,.,P:r under "~.:nmiN" and "Qu~lrty" as specified in permit
<br />~. !Jni[r "~;~ E:" enro: r;umher ,f samrh• ~~~easu-::'.ent:, d~~ring momloring period that exceed maximum (and/or
<br />minimum or 7~ .,. average as appropri •et pcrmt -c p:iremc^! for each parmeter. Tf none, enter "0".
<br />8. En;c: ':`:-en.:~nr•~ ,~ 4ral~~ce,.~ !:nth _+ '.:.,,rp/e A-!•osur+~enr" (t,;h~:,l Frequency of sampling and analysis used
<br />during.; ;,cnat,r-r.• ozn~.i'~ a:.. as ':~° ui: l;rgvin m; ~ r" s~ecifiea it ^^rmit (e @., 'nter "Corer,' for continuous
<br />:monitoring, "li?" `ur one ta, F. r •• z~Y., ' !; ~ ~" for cne day per month, ''i.90" for one day per quarter, elcJ
<br />9. Winter '~;,,mpr ~ '~•• •" bu,h a; `.:.n;.lr ,+.~.•,:.-e.n~,r' actual sample OPe used during monitoring period) and as
<br />"Pe-Wert Renrrrt•rnenr,' t' g.. Er.!cr "(ineb" for indivtdtua sampl^., ~'?dflC" for 24-hour composite, "N/A" for
<br />conOnuous monitoring, etc.;
<br />io. 'Nhe-e violations of pernui rcquircmcnts a•^ :~~pn.,eu, attach a brie: explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitonng period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/Title ojPrincrpni Fx2culirz 7~rer" with "Signature ujPr+ncipn! Executive Officer ojAuthorized
<br />Agent," "Telephnna A'urn6er," and "Date" at bottom of form
<br />13. Mail signed Report !0 O13icr(sr by dntc(Si ~pc.ified .u pernut. Retain copy for your' records.
<br />14. lvfore detaiiea instructic::s for use of thin Dt r.•iea, zz .Llnnir~ring Report (DMRJ form may be obtained Gom Office(s)
<br />specified in permit.
<br />x regal Notice
<br />Tfris retwrt es required by !sw t"s.: U.S.C. 13tt3; a'. C i .R 125.27). Failure to report or failure [o report truthfully can
<br />result in crval pcnalues rent to ex'a:rd w;(r,~0 p ".r day of viulahoo; or in criminal penalties not to exceed x25,000 per day
<br />of violation, cr by trprisonment for not more tt v me +:;ar, or !-y both.
<br />EPA Form 3320-1 (:rev OF-9h)
<br />
|