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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 hotus 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, aad
<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 duetted at entry of [hat information already
<br />preprinted.
<br />2. Enter "Permirtez Name/Mailing Address (and facility name location, if different)," "Permit Nu;nEer," and "Discharge
<br />Numter" where indicated. (A separate form is required for each dischazgeJ
<br />3. Enter dates beginning and editing "Monitoring Pzriod"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sarnplz Mtasurzmznt"data for each parameter under "Quantity" wd Quality" as specified in permit. Average" is
<br />normally ari[ivnctic average (geometric average for bacterial parameters) of all sample measurements for each parameter
<br />abained during ".Y.•,nirorizrg Fzrio l"; "iAaziwum" and rL,urintzrm" are normally extreme high and ton measuements
<br />obtained dicing "i~/LrzilorLZg Pzl-icd". (Note to municipals with second^ry tmalment r.quirement: Pnter 30-day averxga
<br />of sample measurements under- "Avzn~g~,"and enter m::,cimum 7-day average o'sarnplc measstmcnts ob.ained doing
<br />monitoring period under "irlaximurz.")
<br />6. L-ntcr "Pere:riz ke;;uir~mart" `or each parameter undrr "[arm:!%p~"and "Quality" as specified `n pcrmi .
<br />7. Und_: "T.'o E-" enter ~urbcr of s^np:c n-xusiremcu. u._-,ng r.~oniloring p~-iad t;~.' c.:ceed maxirar m (aad.'ur mir~.-. m
<br />or 7-uay a~•cmge as appraprias) permit rrqui.^„ment Cor each parameter. If none, unt;:r "0".
<br />G. inter "F,-r..;u_r,_y of :n ~!}sis"both as "Ssvpl~ Pii= rsn:,:nrni" (actual ir2quancy of sampling cn5 :i~a;ysis used during
<br />n or.ite~ing j. riod) and as "Pzr;,u; 2grrir,:;n.n!"spe_+ficd :n perm:'.. (e.g. L-nter "^our," Ccr continuous monitoring, "I/7"
<br />Cor one c;~y per vn:e:., "1/30" for ene day per mont:r, "1/90"for one day per quarter, etc.)
<br />S. '„n'er "Sconfh: T,.pz" both as "S_•~aF!z .'~d_a;u.e~runr" (actual sample t;g.~: u5_d dui ~;g monitoring period) tnd as "Pznnil
<br />ksguirznznt," (e.g. Enter "vrah" for individ!~a] ,a~nplc, "34H^" fo- 24-hour composite, '%+'/A" for continuous
<br />monitoring, etc.)
<br />]0. ti"sere rrio'.ations o; permit requ[remects a*e reported, avaeh a brief e>,p'a_netion to describe cause c~•d eorrcaive actions
<br />to be ta!cen, and reference each violation by daft.
<br />t 1. '; "ro dischar~c" occurs during moni~:ning period, enter "Ne Discharge" across form hr pluce of deer enGy.
<br />12. Enter "Nmn_.T.%rL cf F,~insiFa! Err.ulive G~.~r" with "Sig'7zul;n~s of Prtrz.i/_tl /:rt_-rr!ivz G~•_'_'r of Ant:rorc~d
<br />Agzz:r, ""TelrTl:cnz Numher,"and "Patz" at bottom of form.
<br />' 3. :~. iaa siyred aepo ~ to C Tce(s) by date(s) specified in permit. Retain copy Cor your records.
<br />.•:. ? :or dc[ai':d instructions Con use of (his Disc;horoz ivfoaitoriug Re!'srr (DiviRJ fcrTn may bo oL-ta'ned from CCGce(s)
<br />specified in pcrrnit.
<br />1~.e~a1 I`d` ®~IlCe
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R 125.2Tj. Failure to report or failure [o 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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