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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, 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 directed at entry of that information already
<br />preprinted.
<br />2. Enter "Perini(tee Namz/Mailing Address (and facility name/location, if different)," " Pernrit Number;' and "Discharge
<br />Numhzr" 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 "Parameter" as specified in monitoring requirements of pertni[.
<br />5. Enter 'Sample Mzzsurernzut"data for each parameter under "Quantity" and Quality" as specified in permit. "Av>_r.r$z" is
<br />no>*nally arithmetic average (geometric avenge for bacterial parameters) of all sample measurements for each parameter
<br />obtained during 'S"/loniloring Perir,,d"; "Mzrinunn" and Nfiniu+um" are normally extreme high and low measuremen`s
<br />obtained dw~ng '^:1~nito;ing P_ri ,y". (Note to municipals v+ith secondary treatment rquuemcat: Enter 30day avera,;c
<br />of sample met surements under ".1v_,ngz,"and enter maximum 7-day average of srmplc measurements obtained durng
<br />monitoring period under "Maximum.")
<br />6. Enter "Per ~. it I~4ufrzmzn!" for each parameter under "Qaantity"and "Qrrolity"as specified in. pernit.
<br />7. Unre- "A+~ F_*" core' numSar of sample measurement during monitoring period that csceed ma ci,~um (anc',+or minimum
<br />or 7-Pay averaQC as rppropriate) permit rt;quiremcr.t for each parameter. ]f none, enter "D".
<br />B. .:n4r "F, :~u z}, cj,:nolycis" both ss ".Slrnplz ,'<-,'_•in~rzrn~~,rt" (actual frcqu~ncy of sWzpl!ng .:nd anslysis uses; during
<br />monitoring pcrioc') ar.d as "Per„n.'[ Rz; rrirzmznt"specified in pe.T.it. (ag. Enter "~rnrr,"far conriueous monitarn„ "1/7"
<br />far anc any per woe!c, "1/30" fo: one day pea month, "//90"for one day per quarter, etc.)
<br />S. Cnter "S.+mF/.' T~~rz"both as ".Slrnpla Afzasrr;arrzut" (actual sample type used during monitoring period) and as "Pzr,rit
<br />Re7ui.smeu," (a.g. Pntor "Cr.~E" for individual sample, "14ff~" for 24-hour composite, T//A" far contineous
<br />monitoring, etc.)
<br />' 0. PJ'terc vio'.aticns of paanit : equic,:ments are reported, attach a brief explanation to describe cause and corrective actions
<br />to be taken, znd reference each violation by date.
<br />11. T."'no discharg;" occu-s during moritorin~ period, enter "Ida Cischargc" across form in place of data enhy.
<br />12.::nte^ "ACnne/Tifrs of ^•irrciFal F,xzcutivz r~~zr" with "Signa[vr2 uj Prin.:i~:+! Fxa'7r~iva C~~er or Arr1lrcrizeL
<br />Agent, ""Teleplroue Nwnizr, "and "Doti" at bottom of form.
<br />] 3. ,'flail sigae3 Rercrt to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for ure of this Gischa,-o ,V,rti[oriag Rz~srt (DN%RJ form may b:: obtained frcm C!3'ce(s;
<br />specified in permit.
<br />This report is requi; ed by law (33 L'.S.C. 131 ~; 40 C.F.R 125.27). Failure to report or fai Iw•e to report truthfully can result in
<br />cavil 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 aot more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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