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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 2046Q; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />general Instructions
<br />I. If form has been partially completed by preprinting, disregard instruction directed at entry of that infomtation already
<br />preprinted.
<br />2. Enter "Permiltee Nome/Moiling Address (and facility name location, if different)," " Pzrntit Number;' and "Discharge
<br />Nunrbzr' 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 "Paromztzr" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Nfzasurzmznt"data for each parameter under "Qnanlity"and Quality" as specified in permit. "Avzrnga" is
<br />normally arithmetic ave-age (geometric average for bacterial parameters) of all sa nple measurements for each parameter
<br />obtained during ",L,'.nilw•ing /'~riod'; "blaxinruat" and hli.rirnew±" aze normal:y cxfreme high and ]otv measucrrnts
<br />obtained during "A,1-.,u! ,rind Per i-.d". (Nett to m~.micipals ^: ith secondary trca5rsnt rquicement: ~ntcr 30-day avera~^
<br />of sample mesurcmcnts under 'Avzrvb~,"and enter ma;:imvm 7-~.:ay avomge of sc nple mcasurnc:nts oblained dur.,rg
<br />monitoring period under "Maximum. ")
<br />6. Enter "Pz:-nir Ra7uire;;;rnt"far each parameter under "Quantih "sr.d "Qeality" as specified iH pcrm~t.
<br />7. Under "No F.x" en:e- number of sample me. sure-e~• during monitoriH~ period that e~ cecd maxir~.~m (cnC/o- sin;-.
<br />or 7-day secragc as anprcp~atc) Hermit requirement fur cacti parameter. If none, color "0".
<br />II. F.ntcr "F.zq¢~>.n~y rfln~li~sis" both as "S_r,u; l~ A!!usn+•zrnta+" (ac[us~ fr:,tuenc;~ of s:.mpli-;; and an;lysi, used durir3
<br />monitoring period) an3 as "Pzrnri! R.~;,r.i;•„nr ~;,!" specified in Hermit. (e.g. r-,nter "~o,d," f.,r continuous monitoring, "1 /7"
<br />for one day per wool:, "1/30" for one day per mont;r, "1/90" for ore day per quarter, tic.)
<br />9. Enter "Sarnpl~~ T»pz" both s "S rmrle L1 •;uuraa;zr !" (actual sampla typa used during monitoring period) an? as ".r'.-, r,ri;
<br />R_aui;~rnzat," (a.g. 8ntcr "Gnat" for individual sample, "24N~" for 24-hour composite, "?r/.1" for eoctineous
<br />monitoring, etc.)
<br />] 0. Plltere violations of ponnit requirements are reported, attach a brief explanation to descriL•e cause a rd cnrrect~ve actions
<br />to be taken, and reference each violation by date.
<br />] L If "no discharge" occurs during monitoring period, cntcr'Trn Discharge" across form in nlacn of dots citry.
<br />12. Enter "Namz/Titl~ of I'rincipa! Fssutlvz Gffi,-ar" c;;th "S+b~r+alure cj rri,r,ac;/ ~r~c.diva Gffi:~r cf ArdS,;i=s1
<br />Rgent,""Tz/zphoue NumPzr,"and "Data" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified i^ permit. Retain copy for you' rccnres.
<br />14. Mores detailed instructions for vse of this Dir,:iurg~ Mwriloriag RrF;;-[ (D;v.'RJ fo-n mry ba ch<_incr' from .^.'.^c~;~.)
<br />specified in permit.
<br />This report is required by law (33 U.S.C. ] 3 ] II; 40 C.F.R. 125.27). Failure to report or failure [o report truthfully can r;sult 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 year, or both.
<br />EPA Form 3320-1 (Rev. 03199)
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