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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 />faci]ities, with a weighted average for major and minor facilities of 18 hours per respanse, 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/Mailing Address (and facility name location, if different);' "Perini! Number," and "Discharge
<br />Number' 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 'Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample iYfaasurenrant"dada for each parameter under "Quantity" and Quality" as specified in permit "Av gage"is
<br />normally azithmetic average (geometric average fcr bacterizl parameters) of all sample measurements for each paramele*
<br />obained during 'SYfonitoring Fariod"; "i.fac5nm;t" and ,L;urimunr" are normally extreme high and low measm em enls
<br />obtained during "i~i,aitorfng Pariud". (A'ote to n:uaicip, is with secondary treatment rec,~u:rment: Enter 30-day average
<br />of sample mcasu; ements unde- 'Average, "and cnier maximum 7-day average of se mple mcast rements obinined dur~ b
<br />mortitoringperiodunder "hfaximurn.")
<br />6. Enter "Pennii Regniremenr" For each pr rareter unc:er "granti.ry"and "Quality"as specified in permit.
<br />7. Und_r "Ido F.::" enter number of samp:c n c~s'~-.n~ct d~-'sg mouilaring period tact c:ueed maxim:.m. (r ndlcr mim c.m
<br />or 7-day averabe as appropriate) permit rec;t:':.-nenl For each parameter. Irnone, enter "0".
<br />8. inter "Fr;~ueney ojAnalvsis" 6th as "S_•rtfle bLasr~enun(" (actual frequency of sampling and analysis used daring
<br />monitoring period) and as"Fan,ti! Ra7rri,~.,ttat"specified in ,~cmi:. (e.g. Enter "~o.u,"for continuous monitoring, "I/7"
<br />for enc day per tveelc, "!/30"for one day per moat, "1/90"for one day per quarter, etc.)
<br />9. °nter "Sin;;cla Typa"both as "S_ ~rpla ,1 iz crurent_,rr" (actual ss:n~ le type used dur ^g monaoring pe~od) az~d as ':'.:.vni(
<br />Reyuirernart," (c.g. Enter "Grab" far iadivid_al sae~ple, "14H~" for 24-hors composite, ">`.t/A" for continuous
<br />monitoring, etc.)
<br />10. F!raere violations oFpermit requireme, is ere reported, rilach a i;rieF explanation to describ: cause a,d ecrrec[ive actisis
<br />to be taken, and reference each violation by date.
<br />11. ?f "nu discharge" occurs during monitoring period, entry "~.'c Discharge" across form .n place of data entry.
<br />12. Enter 'SUarur/Trtla of Principal Fs.~c-utive ;~~a-" svii}t "Signanrre of Prin_1! _~( Er.,,-r•rive Geer of Auilturi>ecl
<br />Arant, ""Teleplrcne Number,"and "Data" a[ bottom of form.
<br />13. ;vlail signed Report to C,Tice(s) by date(s) spe.;ificd in pemtit. Retain copy For you; records.
<br />14, "~iorc defai!cd instructions for use of this Discharge irlonitoring fLpat (DivI12J feint may be obtained from CTcc(s)
<br />specified in permit.
<br />~.~~~,~. I'~~LE~~
<br />This report is required by law (33 U.S.C. 1318; 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 year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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