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Paperwork Reduction Act Notice
<br />Public repotting 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 1 S 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. Enter "Permittea Name/Moiling Addrass (aad facility nameflocation, if different)," "Permit Number," and "DiscFzarge
<br />Number" where indicated. (A separate farm is required far each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each 'Parameter" as specified is monitoring requirements of perntit.
<br />5. Enter 'Sample McJSiU'em3)]l"data for each parameter under "qua;rtity" and Quolity" as specified in permit. 'Average" is
<br />normally arithmetic average (geometric average for bacterial parameters) of all sample measurements for each parmeter
<br />obtained dur;ng 'S~:o;rkcring Fsriod"; "d4,uinan:r" and ,lu°ninrtnrr" an normally extreme higl• and love mcasuromzuts
<br />obtained dwing "ivia:;Norrng Perix!". (1`!ote to municipals wi0r secondary treatment requiremeit: l:r4e- 30-day average
<br />of sample mcasuremants under 'av--rage,"and cote, mzximum 7-day average of sample meant remeats obtained dur'~g
<br />monitoring period under "i/,zrirrurr.")
<br />6. Enter "Pen:rii !tom?ub arrear"for cash parameter under "~`r~,rnti!j" and "~uulity"zs spccired in p,:mit.
<br />7. Undo ~ "Nr, Fr" enter nurbcr of sa.r;i c rre~sur.r!mc:;i ~~.^i~;g r.oniroring period !h<.: exceed ma.:imr~rv (ac~~_'c ~ m_n' m
<br />or 7-day aea-agc as a; propr.Y.c) ;xrnril regtr;rem~nl .ror each parameter. If cone, crt.;r "0°,
<br />8. Hn~cr "Fr_;u_; ~~ ojri,v/yai:." bosh as "S, r.rtL ii:s:r.cni ar' (actualsequcncy of sampling a~,d ana'y;is used dur.,-;;
<br />r-onito~ine perio;:) and as "F,:,;.t;i /L~.luir=,reui"sneci&cd in pc-.r.C. (e.g. Enter "Cc,rf,"fo- continuous monitoring, "1/7"
<br />for occ day per ,vea';, "1/30" for one day per mono, "1/90" for one day per quarter, eic.)
<br />9. Eat.. "Sa,apL TyFe" Goth zs "5~,;;j le -::e~sro mint" (actual s r-rp'c ;~}••.: used du-'co mnrritori;rg pc;iod) aed as "P:,vai;
<br />Re~ui,-zrnznr," (c.g. Cntr.; ";r'1•" for individual sariplc, '24!!~" fur 24-hoer ecmposite, 'S}!/A" for eoetinuous
<br />monitoring, etc.)
<br />10. 1~rre.~ violations of pers.i: regeiremens e-c reported, ar_ach a Brief explraation to dcecribe cause fad corrct Cvc r•cCcas
<br />to be ta!cen, and reference each violation by date.
<br />11. ?f "no discharge" occurs during mor~iioringperiod, enter'7ic Disc~r~sge" across fe!-m i^ pIzee ofciata only.
<br />12. L-nter '%Jurrs/Tiile of PrinciFa! ~se:;erlive /~•_'_•r" with 'Si6nuLu~t of Prim;/. ~l ~:acrtive Gfjl_e,- ~j Auttroriz,;.l
<br />Agau, ""TelaFirne A'mnber,"and "DJte"at bottom of form.
<br />] 3. iviail signed :epor i to C~ u~ce(s) by date(s) sp;:cificd in pero:i[. Ae[ain copy fur your records.
<br />14. ~ •iora de:aited instrucfio.rs for use of this Dis~ha;bz ivl,nito,~ing 2Fari (Di/iR) fo~~ may b~ obtained from CTcc(s)
<br />specified in permit.
<br />~..G',~c ~ ~©'~lllC~
<br />This repot, is required by law (33 U.S.C. ] 318; 40 C.F.R 125.27). Failure to report or failaze 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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