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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 respoase 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 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 a[ entry of that information already
<br />preprinted.
<br />2. Enter "Permixee Name/Mailing Address (and facility nameAocation, if different)," "Permit Number," and "Discharge
<br />Nrtnth~r" where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monilcring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sanrpk M~asurzm_;rt"data for each parameter under "zrantity" and ~itrolity" as specified in permit. "Average" is
<br />normally aritlunetic average (geometric average for'oactcrial parameters) of all sr n:ple measurements for each parameter
<br />obained during "~lfatibri;rg Period'; ",Nazirne;a" and 1.1i:;~„r;nn" are normally extreme high and low measuremens
<br />obtained during ",4!,rtito; ing Paricl". (Noic to municipals with secondary treatmcot requirement: Enter 30-day avera~c
<br />of sample m~ suremcnL^ under 'i'vaa~a," and c rtcr ma::imum 7-°_ry avcr2ge of sn: rple meas~.iremcnts obtained dtuing
<br />monitoring period under "P/laxinttrnt.")
<br />6. Enter 'Ien.,ir Ra?uir anent"for each parameter uadcr "~tr_uvr;t;~" r-d "[iu~liry" rs specified in permit.
<br />7. Ur Bet "T!o !::~" ectzr number of sample mrsurz-.:::i durin~~ r.nnilnr.u~ :=rod th rt e.:cecd m-,;.cimnro (ancVur mini LLrn
<br />or 7-coy avc-age as appropriate) permit rcqui:cmca fur car.!V ;u~::nmtcr. Ifnonr., rir_r "0".
<br />g. "Hier "F,z3van, y cf,k'aalysis" both rs ".5~,.;r l.• ;.:_•s ~ z~r '" (cch ^1 frr_,u_7cy of ~_~aplin~ and analysis used during
<br />mnnitorng period) an _' as "Pt't'rrill2 trir~;n-;:~" s,~c.:;ftd in acr;ai:. (c.g. °.nter "C~.:r~," Cyr continuous monitoring, '7/7"
<br />fcr one day per wee!:, "//30"for one day per month, '7/SO"far cn~ gay per quarter, etc.)
<br />9. Enter "Su+n~.'. Typo"both as "S~,rrl. br _~crn~•.;~a:'" (c _;uar ssm~lc ty,,_ used dur'r, monitoring pcried) and as "F~;;ni!
<br />2;/triremear," (e.,ry. enter "Groh" for +ndisi:'c>: s.:n-p!r; "2?I/; "' for 24-bcr.r ca,r.~~osite, "`.r/A" for continuous
<br />monitoring, etc.)
<br />' 0. there violations of permit requirements rte r..rcrrr.', ef,°eb a S~.of c:n!anc''on to d_=cr;be cacse and corroc,we actions
<br />to be taken, and reference each violation by cL1*.e.
<br />11. If "no discharge" occr-s during mcnito-ing i.or;od, eat ~r "1.'n 1: ~scharLe" arross fo-ru in place of data entry.
<br />12. l;nte~ 'N.nne/Tirt~ of 1•rin:;iRa! F.r.•::~r;;~ ~~•~ " c;11, "Sio,:~^ov of Prine;,-:1 Ere.:elive Cffi_•rr cjAuthrnz"I
<br />Agent, ""Telephone Nwnhsr, "and "Date " at L-ottom o f form.
<br />' 3. Mail signed Report to OfEce(s) by date(s) spocificd i.; F. merit. Rctai^ ccpy fo-your records.
<br />14. More detailed instructions for use of this DCs~lr~r- ~ .'~i•,ni!;rin~ R.~>, t (~;,;RJ fc~ n may be obtained from OTCC(s)
<br />specified in pemvt. V
<br />11~~~Flh 1~T~~~',~
<br />This report is required by law (33 U.S.C. 131II; 40 C.T'.R. 125.27). railure 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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