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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vazy from a range of 10 hours as an
<br />average per response for some minor facilities, to I10 hours as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of ] 8 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, disregard instruction dvected at entry of that information already
<br />preprinted.
<br />2. Enter "Pznnittez Name/Mailirtg Address (and facility name location, if different)," "Permit Numl,er," and "Duch,arge
<br />Nunrhar" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing ",Llonitorirtg Prriod"covered by form where indicated.
<br />4. Enter each "Parattteter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample /viZ71'Ur'2ndiil"data for each parameter under "Qusntiry" and Quality'' as specified in permit. "Avaroge" is
<br />normally arithmetic average (gcomct c average for bacterial parameters) of all sample measuremonts for each parameter
<br />obtained dining "ivio%:it .: my f~%•io l'; "i.k ~xinu~,%t" and blur%.aurn" ar normally extreme high and loc+ neasurements
<br />obtained during "i-::nitori,rg Prrio,f". T'ete to mwticips]s ~.ailh secondan,• treaknent rcyuiremeat: Eaicr 3C-day averse
<br />of sa^~plc measurements under "lJv~; ~6~,"srd erter rt,^.;:imvm 7-dcy avera„c of sc nple measurmcnts obtained dar' 3
<br />monitoring period under "i/:,lzirttr:r;t.")
<br />6. Eater "Fern i! Rr;ui; _rn_at" ter er. parrmCe_r cud,:r "Qr~a,%ii1~~"%ad "Qrrality" as specified in pcrni:.
<br />7. t:re:er ";~'-, F: " e -~. .;umcer c":. ~ -,~:= ~n_: c. ram: ~t dsriny moni(or',to -zr.'od Gtat exceed maximwm (anci'cr inin i.: •;a
<br />o; 7-gay ovcra~c as a ;arapict~) pe ~ t'; n::rremert fa,-carh pcrametcr. Ifnooe, enter "0"
<br />u. .~.nter "rP_ ~t: d,Gj~ r~`i it 11}'SiC° i:~~.~! r~ "CJi~i~td ~.i '!Sr~'GIiS1~; r'r ~. Ch'~l fS~^y'dCDCy Uf SEl'.lpllrg fnd aP. ~~S15 YStG C'LI.IO~
<br />:~JnlfOln~ pert el.) uL~ C.5 ~ i~J ~, 'i RL . _ !.d"5 ICS lied in p~iTn lt. (0.o. FntBr "~Ol7 r," fOr COntIt1UOLLS ma]IIORn~, "//7"
<br />for one day per v: ec!:, "1/30" `o mv; ricy pc- ,nonih, "1/40" for one clay per quarter, enc.)
<br />9. ~ntcr "S ~,%~; J~ T.t: ~~"Le,~ i as "."_~• ~ t• . ._ ~ ,.~ rn!" (^ctual sample ty; e used during monitoring period) end as "^~n,ri!
<br />2 ui,~,n_ut," (,.;;. 9ntc "Graf" for i':dividurl sample, "14H"" for 24-hour composite, 'SV/R" far cor''rua.~s
<br />monitoring, etc.)
<br />I0. \'/!tere violr_iers n°~ a t o~~ `.'cmen s crc r. or:ce', ~ r4.ch a lsrief exp'anaticn to dcscr;be ca,rse ~^d cormcuve act4 a
<br />to be ta'.cen, and reference each violation by dare.
<br />I1, if"no wx;rart,e" ucc rs uu-.ng -n. '~ , in;; period, cni~r "A!a C schlrg~" ecross form iu place of dares entry.
<br />12. °.ntcr "Nw,rr/Ti,!- rj r~~i,f_i%J! ;:: ~_~•dr2 :J~.,'," ~-r [h ':Si;;r. ~Ltr~ .;f P,•Lre;r~t F.x,;,-utive G~a~ oj`nrtir.r;z,rv,
<br />~lgznl,""T~lzp.'ro,r,:N~~,;rFz,;"rnd "%:~r:"at bottom of form.
<br />13. rvlail signed R~;~cr~ to ::"-ces)':, 'a:;.; specified in permit. Retain copy for your records.
<br />14. i/.ore detciled instructi,;rr. for '~ e"!'''s I''i.._h1,6- ~L;snit„iao 2•i .r7 (Drb1RJ form may be obLrined Erom C; ice;:.;
<br />speci: ed in permit. ~~^^ ~Tq~ +~~e /~
<br />~J lvJ~i ~V 'aY`I.ll U.lv
<br />This report is required by law (33 U.S.C. 131 ~; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can nsllt is
<br />civil penalties not to exceed X10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,
<br />ar by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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