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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 O.`iice 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 drrected at entry of that information already
<br />preprinted.
<br />2. Enter "Pennittze Namz/Mailing Address (and facility name/loca[ion, if different)," "Permit Numher," and "Cischorge
<br />NumFzr" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing '4Lloniroring Pzriod" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements ofpermit.
<br />5. Enter "S~raFlz rLLa~urzrreat"data for each pzrame[cr under "~ua~:lity"and ~ualiry:"as specified in permit. 'Averogs" is
<br />nomrally a,ithmctic avenge (geometric average fur bacterial parameters) of all simple measurements for each parameter
<br />obained during '7Ytonivring Pzriod"; "; v:axb:nrr,r" and tifiai,,;ura" arc normally extreme bigL- and law neasuremeuts
<br />obtained during "'rionit;rbrg Pzr•ic1". (R':e': :o rntr:ric~pe;s ~:~iti secondary'scatmcet requirement: !:rater 3C-day average
<br />of sample m.ar.urcmcats unde- "Ara• ~6;,"a.l e ir_: na:imum 7-dry cver<ge of sample meast.rements obtained d.c
<br />monitoring period under "N.axir,:um.")
<br />6. Enter "Perrai~ Re;nri..•rna+t" for ece t ;.~:mc?er Lnd~- "~r~~nritt~" r~ d "L.+~a/ity" as specified ii pecnit.
<br />7. Ur der "No F°" entc.' number of sam ae m:: care.-c ' ch:nnb monitor ~~ r.c~od t;rr[ r• eced max~,rr:rn (and/cr mini , m
<br />ur 7-day avc:~ge as ap~ropriata) pcrn't n uir~ncr' "or each parameter. If none, enter "0"
<br />ft. ;n[cr "F, •~rrar~y cf A2~Ipeis"bold : ~ ~,irt, . ~ , ,,,i •.•r" (rcb;sl fr;; uancy of sc~npl;og aad analysis used durin"
<br />moaito ing,~criod) r.-d es'Yz,,.r- h_; ~ ,_ . ~. .:r•' red in ticmiit. (a~. ~ntcr "~•,,,i,"for cont'nuou:: monitoring, "1/7"
<br />for on:; day per wee'„ '7/30" for one d_:y pe- ncu::~, "1/90" fr,r one day per quarter, etc.)
<br />9. Iiatcr "SonrFlz T r'"both as ".S~rr; !r ; . ~~ ~nrv,,; •,.."(,:dual sample i;-~: used during nnnitcring period; acd as ","_.'rnir
<br />RL'~RII'_'1 ii~,l(," (a.g. I'~ri„r "G,~_~~" fo- i,..°evid~.r' e^~nnlc, "141/7" for 2~-hour composite, "T.'/A" fo- continuous
<br />monitoring, etc.)
<br />10. C/here violaticns of ne-mit .e~v~-cncrfs air epor :r, :ac;i a bri~f e;:p!anat;en [o describe cause z rd eom:ctive actions
<br />to be taken, and reference each violation by dz.e.
<br />11. If"no discbaagc" uccu. s dur'n„ -~o~~!;~ in,; , ~, e ~' _- "„o `;'S.'~ :~~a" across fcrm i.i place of data entry.
<br />12. Suter "Narrz/Tii;e ,J f,-iruip _~l :.'t':~ G~~ .. ~,'th "Si,;,r.~te; ~,~ rf Prirr.:i~at F. re 7Ni vz C~-zr ~f AvKrorL;~J
<br />Agznt, ""Telepltonz ASr,nh.r,•, "and "I_-ar_ " at bottom cr fom.
<br />13. ;vlail signed Report to Cf'?ce(s) ~;, ':'~ ,:; ;peer?__ L. ].e init. Retain copy for your records.
<br />]h. More detailed inswctioos fe ~,:_ : " L''`s Drs^;, ~,~. ;~/~•;,i!o. ino .2 ~ „~ (C,?,R) fu ~n may b~ obtained Gom Cf ~ce;s)
<br />specified in permit.
<br />~- -~ o
<br />~c ~~ ~ 1 ~ ~~~~~
<br />This report is required by law (33 U.S.C. 13 ] ft; ~0 C.P.R 125.27). Failure to report or failure to report truthfully can result it
<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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