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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, 40l 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 "Perrnittee NamelMoiling Address (and facility name location, if different)," " Parmit Numlr2r," and "Gischurge
<br />Nermh:;r" where indicated. (A separete 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 permit.
<br />5. Hater 'SJ,np/e Measurement" data for each parameter under "zuaMiry"and ~hraliry"as speci Fed in permit. 'Armrage" is
<br />normally arithmetic average (geomcC-ic average for bac+._rial parunrters) of all sarnplc measurements for each pua;ncter
<br />obtained during '9Vio,ritoring Peri,d'; 'SLLuimem" and Mi.,ti:;um" arz normally entremc high and loly measurements
<br />obtained during "::doniNringPari..j". (Noie [o municipc!s will secondrn, :re:.trncn; rr•;eirenertt L-nter 30-day avera;,•c
<br />of sample measuremeuts under "Average,"and cote; mazimc n 7-r~^.} av rzge of r.:.npfc mecsurenent_<. obt; `ncd dw:.:g
<br />monitoring period under "iYlaximum.")
<br />6, :'.Hier"Fer„It/ie ~~i,i,'e,i7e111"for Ccc^.Ch parametei 4ildCf"rP;,,di~~,, .-_, "•yu:lily"aS Sp.CIt1Cd np.;rTli.
<br />7. Unc:cr "Pl. F°" enb, lumber u."sample mcasr:re-a i~. during noni(r., ~ -od 1'~ ' ~ c~_cr: ne;.in.m (rn~,'or rni;;t:,..~m
<br />o: 7-gay average s aP2ropriate) permit rcquiremert for each par. m%tc~:~lf nom., e;~ie* "0".
<br />S. tiler"F',~;nea_3•~fA,~~tycis"both a, "S u,+/de,~ew•~e,nr .'" ._h,~l "io_v.:~c,~of,. lpli ~:mi::nal}sisuseddu,in;;
<br />;r.oaito~ing perod) ant as "Pei,,,it Rz.;.aire.:,rr;t" specified irl lanai[. (e.,. °.n[cr "" " for cunt'uuuus monitorin„ "1/7"
<br />fur cn_ c:ry per wee::, "1/30" for one day pe monL'l, "I/70"fer occ clay per quarter, c~c.)
<br />9. ':.ttcr "S~,n! (e 7jp_"L•olh as "SamF/e li_~rl~reo, ~,.;"(•~ctual sample tyro used durir;, e~uniinring pc-ird) :n1 as ","ter„,ir
<br />Re~ui;~uu„!," (e.g. F,ntor "Gr~F" for individual c:!mple, '7dll~' for 2~--boor c~mposiie, '"lr/f'"' for con ~auous
<br />monitoring, etc.)
<br />]0. ~'."lcrr riolttiuns of erenit recluiremects are rapor~cc! cttch a h~,~f e°~'aon'~on to disc;i•ae cause r^d con'ec:ire acts ;ns
<br />to be taken, and reference each violation by date.
<br />11. ]f "no discar~c" occurs during monitoring period, ent•_r'?;o )iisebr ~~"across frin in p!aco nfda':. c,~try.
<br />12. '-ntcr "N1ave,Tide of Prin;;ipa! Exe vtive Geer" v.ith "Siswcs r /J' Pr1n1iF.,r E.re_•e•rivr :fj"",_.:, of .fe~lrri_e:<
<br />Agent, ""Te(eplwne Numter, "and "Date" at bottom of form.
<br />13.:r!ail si;,med Report to CfGce(s) by date(s) specified in permit. _net~;n cun, fcryor :rrcord~.
<br />'k. i~orc; detailed instructions for usa of this Disrlurde ,Li..,i!cr;.ro R.~•,,-t ~T;.,T~ fn n mcy'ea oLt;.ined S'cn C :ices)
<br />specified in permit.
<br />~~~~~ ~~~~~;L~~
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27).: allure 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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