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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 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, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permi[[ee Name/Mai/ing AdJress (and facility name/location, if different)," " Pzrmit Number," and "Discharge
<br />Number' where indicated. (A separate form is requrred for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Perio./"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements ofpermit.
<br />5. Enter "Sample Maasurem~,tt"data for each parameter under "Qtrantiry"and Qrralily" as specifed i^ permit. 'Avrrag~" is
<br />normally arithmetic a,~erage (geomeGic average for brc:erial parameters) of all sample measurements for each pa~mctcr
<br />obtained during '9t-ionitoring .^~•Yicj'; "11, ,cimnm" and hfinir;:um" ar: normally extreme high and low measurements
<br />obtained during '7d:rritorirrg Peri:!". (No:e to munici_.~]s with secood;rry tre2tmcnl r. quirement: L-•rter 30-day ave~~~e
<br />of sample measurements u,~der ".iv~,ro ~,"cod eta- r,a;;imu-~ 7-dry avere;;c of 9e nple measurements obtained d i ro
<br />monitoring period under "rLfaximum. ")
<br />u. Cn[Er "Pan..it R.';virerae.rr" for erE'~ pzrmc'...r vnL.. ~ ";,u_wr!N" r •'l "~h~alil~," as specified in permit.
<br />7. Ur de- "Pl ~ F..r" enter num'.:er cf sa:~ ilz ~^~_surem, n' :h.ring monilor~g pcrad Ih~t exicecd mr':imum (and'c: mto'.._»
<br />or 7-Coy average as appropriate; permii rcnuir_-.,E,t fur aaclr narame:a. If rw::e, ewer "0".
<br />II. ~nlcr "Frz;rreaa~, ofr',;,.lysis" both rs "„n:rf le ;s-.u -srn~at" ~2ct~a1 ftequ' ncy of r.~„rpling and a~c'ysis oscd d.:~c~
<br />morite ing period) and as "Fu~;rit R.epri,~,,: -;u"s-acifi;d in pcrrnit. (e.l;. T-Hier "G„.t,"for contuiuoua monitoring, "!'7"
<br />for one c;:_y per wc~ :, "1/30" far one day per mnnGr, "I ~^0" for ore day per quarter, etc.)
<br />9. ::nte: "S_mFle TyFr"both cs '(S.tir~ !s ;d,:.rvr, e.:~ .r r" (cc,ual sampL t; ~:c rscd dnrin~ monitoring period) ar ~ cs "~ -r.d'
<br />Rzquirem~.rl," (o.g F.ntc* "Gah" for i:d^:idu^I sa;nl;lc, "hr//~" for 24-hour ca:npcsrtq "N/~(" frr cn:'.^uo~s
<br />monitoring, etc.)
<br />10. \Jlaere violations of; ermit -cq~i-cm:•'s arr ~e~.or:ed, cf.-cr r. L:iefc::planation io dcsnibc cause end emrc_twe ,. _,~
<br />to be taken, and reference each violation by date.
<br />11. If "no disc:rargc" occv s during morit_ .in„crcd, c.Y_r'^:o Cscbzrge" across form in place ofda'y c~~tr)~.
<br />12, enter "Namelfitk of Princifa( F.., .:.,tirz .:jTi=.•r" ,'di ".Si,;,rant:-~~ of Fria: i/~t F.c,:arfivr :~ =,• of '~r''!r"~' -
<br />Agent, ""Ta(,:PBare Nw»bu, "and "Gat ~" a[ bottom of form.
<br />13. Yiail signed Report to C~ roe(s) by rat_;~.; specific. i.~ i e ~r~t. Retain copy for yow- records.
<br />14. i.?o*c detailed instructions for use o` f-'s Dis_;uree ;v;•.,,i!srine R.-r:;i (G,~<'l~ Fom mry be obu: ~~cd "rm ~'- , ,
<br />specified in permit.
<br />v'
<br />This repot is required by law (33 U.S.C. 131II; 40 C.:'.R. 125.27). Failure W report or f:.ilure to report truth`ully can rsJt -
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day oC violz io ,
<br />or by imprisonment for not more than one yeaz, or both.
<br />EPA Form 3320-I (itev. 03/99)
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