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 fot 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, 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. If forth has been partially completed by preprinting, disregard instruction directed at entry of that information aUeady
<br />preprinted.
<br />2. Enter "Permirtez Name/Mailing Address (and facility name location, if different)," " Pzrmit Number," and "Discharge
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monircring Period" covered by form where indicated.
<br />4. Enter each "Poromerzr" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Measerreme:rt"data for each parameter under "~uanrity"and ~4r~liq~" u specified in permit. 'Avaragr" is
<br />normally arithmetic average (geomclric average for bacterial pa; amctcrs) of all sample measummcnts far each parameter
<br />obtained during "i/a+ita~i;tg Pariod'; "Mxirtusa" ssd ~Lfin%,;r;un" arc normally er.trcme high and low measuremcros
<br />obtained during "h'WtitG.'lllg P,:rind". (l~'ote to mun;c~pals •.:ith secondary trca~tcnt r.;r.uircment: Enter 30-day avera~c
<br />of sample measurements under "Avzrogz,"and cuter mazir~cit 7-d:y sv~-.ge of sr nple measurements obtained d~cng
<br />monitoring period under "Maximum.")
<br />5. F,n'cr "."ennit Iiz-juir~rre,+t" for each par^..metcr under "~u~lr,ri!~ "a t, "~u:lil}~"as spcciFed i~ permi'.
<br />7. Ucdcr "T.+•, l::" enter number of sample m~~sure-gent during mani;c.;r~ ;:~riod 71tz' e;.crer' m+;;im~~ut (~nc'or minir.;~m
<br />or 7-day average as zpprapriate) permit rquircmert fcr each na mete-. 1;'none, ~atcr "0".
<br />S. '=nG~r "Fr r,/rr,_;:~y cflwly'°is"both rs "S~ugL Age.*c,,,~s;,:. °_Y~et fraqu:ne~~ of sc aplirg and analysis used dung
<br />monitoing period; a.d as "F~n„it 2-jrairs;rr::!"s~~ ~p~d i,t tie-m~t. (c.g. °.nl.r ".~,rr,"f.r cantineo~i5 monitorir~, "1 /7"
<br />fcr one da, p_r wee}:, "//3t7" for one day per monCt, "1/90" fcr crc d:y per uuart~r, r.: c.)
<br />~. ~ntcr "Smnp/~ T,~,~a"both as "Sanr~/e lf~mrae;,+~nr" (cctunl sample t; - : i scd d•L;n~ To titoring pcr.cdl ar~ a_s „"an,ri;
<br />R.•_t.ri,rmzal," (c.g. P-,ntar "Gnz!" for individual rampla, "2411"' fcr 2~:-hcur composite, "N/A" for co7dnuouc
<br />monitoring, etc.)
<br />' 0. \`.rltere violations of permit requirements arc r:nor•ed, attcd-. a l: -ief exp'a~~a~ion tr. P_:.cri~c cause and eoTCCtwe action,
<br />to be taken, and reference each violation by date.
<br />11. `,f "na discbarge" occur during monito-i*"perod, enter "\'n ^'sd:arLe" across form ir, mace o~ data en7y.
<br />12. Enter "Na;arJTith of Pri+:cipal F.x_>~utive Gfji:~•;-' t;ah ';5~~;:~'r•r,~ rf ;'ria, lr.r Er_~rair~~ ;~_~r r.; „+rtha;iz~1
<br />Agzut, ""Telepho:re Numbzr, "and "Date" at bottom of fo: m.
<br />13. YTail signed 2eport to Office(s) by date(s) specified in permit. ^ctain cony for you; records.
<br />14. A.4oro detailed instructions for use of tF.is Cis,:h~,oe ,14•;;ctriri,rg R ;~- > (DrL1RJ form may b. obained from C~ccs;
<br />specified io permit.
<br />
<br />This report is rcquved by law (33 U.S.C. 1315; 40 C.F.R. 125.27}. Failure to report or failwe to report truthfully can result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties ncY to exceed $25,000 per day of violation,
<br />or by imprisonment for vot more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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