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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 110 hours as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of l S 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, BC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. 1f form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permitlee Namz/Moiling Address (and facility name location, if different)," " Pzrmit NumF,zr," and "Discharge
<br />Number' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "M~nit,rina Pariod"covered by form where indicated.
<br />4. Enter each "Poranreter" as specified in monitoring requirements of permit.
<br />5. Enter "Sampla Mzasuremant"data for each parameter under "~xa;miry"and Q:raliry" as specified in permit "Avaragz" is
<br />nc~r+ally aritJtmetic avenge (geometric average for bacterial pa,-anc[ers) of all sample measurements for each parameter
<br />abtained durZ; "Nlonilr~riug Paris/"; "ivbuinronr" and A1iui,r;unr" arc nor;nally extreme higl: and low mcasu-cmc*+ts
<br />obtained dwrng "M;nir~rin~ Parir, i". (Note to municipals r~ith secoudar;~'seatmcnt r..qu:rcment: Enter 30-day ascrage
<br />of ea-npL me. surements under "Avaraga,"and enter maximum 7-may average of s~-plu incasircmcnL obtained der:;g
<br />monitoring period under "Maximum.")
<br />6. idle' "Farah 72aar,i,~amznt"for each parameter under "~ivanlirf" and "[inaliq~" as specified in permit.
<br />7. U.-i cr "Ar~, ~:" enter cumber of sample m~cs;:ri-m.nt during monitoan~ eyed t;~c~ „ :coed mr_:~mm~ (t .i'or minnr~m
<br />c. 7-'._ry average as appropriate) permit requiremcrt for each parameter. If nose, c~t:r "D".
<br />S. T ~~,er "F;.;,,.e-v cj /'nalysis" both as "S„n,~.lz .Lle~srrrun_,rr" (ac[ual free ucne;~ of stmpli~g and aea'}5is used Burin;;
<br />monitoring period) and as "Fzr,ait Ra.Jui;~_rn -n~" specified in pcrnii". (ag.'rnrer "..., ,"for con.:ncous monitoring, "1 /7"
<br />fcr or.c day pcrwee'.c, "J/30" for one day per monfi, "1/90" far one day per quarto, etc.)
<br />~. Winter 'S~nrC• T,~;ra"both as "S~npl~ hLx mr.::na-t" (cetual s. mplc t)~,~c used Btu°.r, monitoring period) rn.'. as "P~nd%r
<br />2.juirarnr,r," (e.g. Enter "GraF" for individu.l sample, "7.411:"' fcr 24-bcm c:~mx~site, ";l/A" fcr continuous
<br />monitoring, etc.)
<br />' 0. ~'.hrere eio'aticns of pcrrnit requirements are rcForcd, aY~ath a beef explanction to dcscr.be cause end coTCCtive ac ons
<br />to be taken, and reference each violation by date.
<br />11. If "no diseha-ge" occurs during monitoring period, entr,r "T!o T;ise'targe" rrross form in n'reo cf da:a cnLry.
<br />l2. Enter "Nmnzl!'id.r cj "ri,r^ir1! F.xa„utire :~_zr" r.;th '[Sig~+,.c:c,: rj F,ir. ;-;/ _1.•1~n_ :~._r cj Atdho;izs.f
<br />6gsnt, ""Telzphonz NumFzr,"and "Gala" at bottom of farm.
<br />t 3. 1dai1 signed Report to Office(s) by date(s) specified in permit. Retain copy fo- yor - n co-d
<br />14. ]ldore detailed instructions for use of :his Disch~rg~ rb;-rriloriag R ;r;r9 (rJ,;:R) 'c-~n clay b~ cb'aiaed from C"'ces)
<br />specified in permit.
<br />e
<br />~oc~il ~ ~ ~r ~~
<br />This report is requu•ed by law (33 U.S.C. 131II; 40 C.Q.R. 1?5.27). Failure to report or fa;lwe to rcpart truthfully can result i^
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day of violation,
<br />or by imprisonment for not more Utan one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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