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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 hams 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, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/Moiling Address (and facility name location, if different)," "Permit Number," and "Dischargz
<br />Number' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "MonitaringPzriod"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter S_mple M asurement"data for each parameter under "Quantity" and'~hzality" as specified in permit "Avzrogz"is
<br />normally arithmetic average (geometric zverage for hacterial parameters) of all sample measurements fer each parameter
<br />obtained during "M~niroring Pzriod"; "Masinurrr" and hfinimmn" ar normally cstremc high and low measurements
<br />oStaincd during "Mouitorrng Pzriod". (Note to municipals wiLr secondary 'scatmcat requirement: Enter 30-day aven~c
<br />of sample measurements under 'Avzrabz,"and enter ma::imwm 7-d.:y averaga of ar,rple mensir.,ments obtained dar'ng
<br />monitoring period under "Maximum.")
<br />6 Entc" "nar~;,il Rayuirzmen[" for each parameter under "Quantir~,"r°d "Quality" as specified in pc.~+t.
<br />7. Unc.r.: ",'.~~, Fs' enter number of sample macsnrc~ent during mnnitnr ~~ ncr+od th ct c~.ccu' maxim_~m (and/or mini;-~;m
<br />or 7-'~y avenge as appropriate) permit requirement for each panmcrcr. 1. none, cnrr "0"
<br />P. °nter "F;zyz~s;r`y of/.na(ysrs" bath cs "Sampl~• b!saursr;zzrr" (achal G,:qu~ncy of s:mplio~ and analy.is used during
<br />monitoring period) and as "Penvit Requtrznte;r!" speci icd in ,~e-tttit. (e.g. ?r.~: "~ont,"fir contin!ons monitoring, "//7"
<br />fer one day per wee!:, "1/30" for one day per montii, "1/90" for ono day per quaver, etc.)
<br />S. Enter 'S,z;nr1,• T;Tz"bath as "Sanzplz ltzasrrrzi;r,:rr" (cctual rample type used du~'n„ monitoring pcricd) and as "I'~nni.'
<br />Rstui:zme,rt," (e.g. P.nter ","ireF" for individual s2,,rple, "24N^" fer 24-hear caniposite, ~;/A" fer continuous
<br />monitoring, etc.)
<br />' 0. P!'rcre violrtians of permit : eeui:ements am rer.crted, atG^.c!1 .. b..ef e;:n!anation to descrbc caps,: end cazective actions
<br />to be taken, and reference each violation by date.
<br />! ]. i"'no discharge" occ,us during monitoring period, enter "No C'sclrcrge" across Porn in plate ofdara entry.
<br />12. L-nter "Name/7"i;lt of P;-irr=;r.zt T;.reczztitiz Gffz: ~r' tv th "Sisra'.~s~ of Frin:irll ~zz~z•tiva G~xr of Au!hnr~zsi
<br />Agznt, ""Telephc:e Number,"and "Date" at bottom of form.
<br />13. Nail signed Report to Office(s) by date(s) specified L~ permit. Retain ccpy for your records.
<br />]4. VIor detailed instvctions for use of this Discha;az Ml~ni!o,ing R~r~n7 (D,l~ fom may be obtained from O~Ticc(r.)
<br />specified in permit.
<br />~e~a~ N~~~~~
<br />Ttils report is required by law (33 U.S.C. 131 ~; 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 imprisonment for not more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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