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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, 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 at entry of that information already
<br />preprinted.
<br />2. En[er "Permittee Name/Mai/ing Address (and facility name/locatioo, if different)," "Permit Numfier," and "Dischrnge
<br />Nun,fie," where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitor•i„g Period" covered by form where indicated.
<br />4. Enter each "Porametzr" as specified in monitoring requirements of permit.
<br />5. Enter "Ssmp/e M ac:o•er.,ant"data for each parameter under "Qusnrity" and ~rralit}'" as specified in permit. Avzrage"is
<br />normally alitlunetic average (geometric average for bacterial parameters) of all sample measurements for each parameter
<br />obtained during "Monil~.ring Period'; 'ALzl:i,.rr~,,," and ~:,Lsauna" ar normally extreme high and lorv measurements
<br />obtained during "iv;onirori:ry Prrioi". (i•;ote to munici, a!s ~: it:r secondary 7eaUncnt requirement: Enter 30-day average
<br />of sample measurements under "Avarag_, a r:d ere: r..a;:imc n 7-dry avrrage of sr nple mcasuro:ments obtained dur:;:g
<br />monitoring period under "ivhximum.")
<br />6. Enter "Penal[ Rr fui~-dre,r!"'nr each pazamete: cad.. "~r•_ r,;ir; "r :d "~.r~liq~" as specified in pernit.
<br />7. Urc'er "rb'n F~" crltr number of s~r.~ple m_e~crc'-~: lr~ in;; meniln~= 13 ;rind th:a c>.cccd ma;imum (an4/or mini.num
<br />or 7-day average as appropriate) pe,-mit nrtuirl.~e ' .. each ; ~ra~naLr. If none, entryr "0".
<br />3. Enter "F~_'~,•~n_y ~j/nJ/pals" bosh rs ".S ~~,r; !~ ;! _ ,,.. " (r t .r frqu:n=; of saapliag end analysis used during
<br />monito~in~ period) an_t as "/'e,-~,~~i 2::1:~i,_r;s ~" ssec':~ul in uc~:~li;. (c.;;.':nr~r "L•o,r;," fnr continuous monitoring, "1/7"
<br />for one dsy per wee!c, "//30" for one day per mu ,;~ i, "//90" fcr orlc day p„r quarter, etc.)
<br />9. Winter "SnaFla T F~"both xis "S.nnrf~ ,:.._ ,. ::•'r " ;: e:oal scmnle ty,~c u,c3 dnr;rg monitoring period) and as "Prnni!
<br />F4.yui.•aa~.d," (c.g. Enter "GrF" fo-' • dig:hurl e^~n 71u, "2dF1~" for 2~!-hota~ composite, ",~l/A" for continuous
<br />monitoring, e[c.)
<br />1Q. P. here Vlnlaherl5 Of pe Tlli( tif1L'; Ci 1CD'S al'L 'y.C- Cd, : <Ch 'r. b: iii C.:p'.an ;1~On in dCS~llbe eanSC £ ]d CnrTCCtIVe aClin nS
<br />Lo be taken, acd reference each violation by date.
<br />11. If "no discharge" occurs during moniLrr i~~ fe: ~ea, c ~'_ "Cc ".: 1'*;;_" across fcrm in placo of data entry.
<br />12. rn[er "IVJ,.,e//'i;L of °rid_ipJ! Ls v-n-'.'~ ;f;r. _, " , lh :^ior:.'~-..r ~f /'r!n •iT ./ F.x: ~uiva G~_er of At+rhor~~eJ
<br />Agznt, ""Telepho,,a Nua,l~r, "and "Daly" at bottom c:` fa ,n.
<br />13. Tviail signed Report to C; rr~e(s) by •~t•s; spceifc i l ;: ~n1L Rctaia cony foryour rerords.
<br />]4. P.-?cre detailed instructions for use o' t'~is rC _;'. ',~; ,,; .,,-ro.;aa Rr. ,,: (I;;nRJ fun may be obtauied from C~cc(s)
<br />specified in permit.
<br />~ .. '°
<br />~:..~~ j~ :i T~TO',~1: ;~
<br />This report is required by law (33 U.S.C. 13 iS; ~0 C.?.R. 1252Tj. Failure to report or failure to report truthfully can result in
<br />civil penalties no[ [o 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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