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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, inc]uding 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, disregazd instruction duected at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/Mailing Address (and facility nameJlocation, if different)," "Perini! Number," and "Discharge
<br />Number" 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 'Paramet_r" as specified in monitoring requirements of permit.
<br />5. L-nter "Sample M~~suremen!" data for each parameter under "Quantity" and [iuality" as sxcified in permit. 'Average" is
<br />normally arithmetic average (geometric average for b,cterial parameters) of all sample measurements for each paiamelcr
<br />obtained dtuing "d1~niluring Paiiod"; "i.4axirrrurr" and .t, ni+rrrnr" are normally extreme high and ]ow measurements
<br />obsned dating "; :nil.ring P~'ric:!". (Vote to m~roicipals Fvith secnar:ary treatT~ent recluiremcnt: P.nter 30-day average
<br />of sample measurements under "Averngz,"and enter maximum 7-day average o`sample measurements obtained during
<br />monitoring period under "rYfasirnurn.")
<br />v. Enter'Tenr.itlie:luiraure+r["for each parameter under"Q;r.~a!ih,,"and"Qaality"as specified in permit.
<br />7. Und. • "11'o Fr" enter namber of sample measurcmem d., imp r cni~aring ~,;nud t1ir.' ereeed m1cimwn (anc,/or mini.run
<br />or 7-day a~ erage as appropriate) permit requircmeni fur each parzroclu. If none, enter "0".
<br />;,. Enter "f'r~qua+_7, r,~`A;r~lysis" bau as "Sara; Is ,.1_•~sur_+„rn!" (actual frequency of sampling and analysis user: during
<br />:r:onitcring p,,:iod) and as "Fa~nit IZ7nirc::+sm" spec~ficd in f.•_~ 1i.. (c.,. Later "~%u%,"for continuous monitoring, "I/7"
<br />for arc day per wcr's, "1130" for one day par moaih, "1/90" for one day per quarter, etc.)
<br />S. rata: "Sur,.rld T g~"l;o[b as "S.:+;+FL +Lleasurun..nr" (at:u.^.' sr nple t;~}•e used der rg monitoring period) and as "Pznrrii
<br />Feyuirzin~at," (e.g. Enter "!irab" for m.dtvrdual sarnplc, "2~'H~" rut 24-bear composite, 'S'~!/A" for continuous
<br />monitoring, etc.)
<br />10. 1t^.rere vio:alions of per.nit requirements are reported, :a:ach a r.-:ef c::planadon to dcsc+ibe cause and corrective actions
<br />to be tacen, and reference each violation 6y date.
<br />11. If "ro discharge" uccurs during monitoring period, enter' i~o isctar~e" across farm in plac,~ of data entry.
<br />]2. L-inter "IVan,:/TilL rf H•inciFa! Exrruliv~ Oj~,sr" with "Srdna!m~~ rj Pr!,r_iF,d Frea,livr Offi~ar of Aut!rori=ed
<br />Agent, ""T,;kphcne Number, "and "Gore" at bottom of form.
<br />' 3.:r4a:: signed 2eport [o Cfficz(s) by date(s) specified in permit. Retai n cop; for your records.
<br />:~. ~;ora dewilyd instructions for use of this Disclr ~rg_ ;';rritcrirrg RaFs,r (CF-rR) f^.~n may bo oSt<ined from Cfficc(s)
<br />speci gyred in permit.
<br />~~~a~ ~©tiii~~
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R 125.2'n. 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 no[ to exceed $25,000 per day of violation,
<br />or by imprisonment for not more Uran one year, or both.
<br />EPA Form 3320-1 (Rev. 03199)
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