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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 ] 8 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 />I. if form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />Preprinted.
<br />2. Enter "Permittee Name/Moiling Address (and facility name location, if difTerent)," "Permit Nvrnher," and "Discharge
<br />Nunrbar" where indicated. (A separate form is required for each discharge)
<br />3. Enter dates beginning and editing "Monitoring Pzriod" covered by form where indicated.
<br />4. Enter each "Parameter" as specified i^ monitoring requirements of permit.
<br />5. Enter "Samplr M~asurernant"data for each parameter under "Qrvntiq~"and Qnaliry" as specified in pemit. "Average" is
<br />normally arithmetic average (geometric average for bacterial parameters) of all sr ~~tp'.e measwcments for each parameter
<br />obtained during ",'bl,nitorrrg I'~ri.d'; ",V,crirnto,r" and /~>i;ri;sum" are nc~nally exi;cmc higr and low measorcncnts
<br />ohtained during "i:fonir,:~ing P~rio_f". (Note to municipC'S rrith secondary tre:tmcn*. rcfrrement Enter 30-day a•,•era;;c
<br />of sample measurements under "Av>rabe,"and enter maximrm 7-day avcc~. of sr -~p;c measurencnLs obtained dcr'.:g
<br />monitoring period under "Maxinr:rrn. ")
<br />G. Cnter 'Tee~ait Raqui,~.„rent" for each parameter under "'iJuaatir.•" a,_;, "~ualiry" as specified in per.-nit.
<br />7. Urd-; "~'~r F " crto- r.umher of camplc m.csurc Went during mnn~'er'r^ .:r cd f~:' c~ =r.C? ma;;imu n (rnUor miniir, rn
<br />or 7-3.-y av~:-aryc es appropriate) permit requi-amect for each para-nzt°.,. ~If none, enter ".7".
<br />R. Winter "Frzlr~.;; y ,f,'n.lycis" hnth a "S..d~(_ ~L;tac~-rar,r>.-~" ;ectuer G.grsc•~ of r :.~linr, and cna'ysi~ used during
<br />monito.ng period) and as'Tzrait R2;:~i,tnr';r!"rccificd in parnrit. (,,.g.'n~cr ", ... ~" `nr con:inrons monitoring, "//7"
<br />fcr ^.ne day pc,- week, "1/30" for one day per month, "!/90" far occ aay per euartcr, ese.)
<br />9. 3ntcr "J];Irf.i= TiT~,•both zs "Sanrrla lldanar,rad" (retool sample t :; nscd dtr'r~ r,~onitnr'ng period) an:; as "P.e;;;,it
<br />R.' i(li'dine.;1,° (e.g. Enter "Gr+F" for individual ramplc; "741i~" fc- 24-hc, r c~:-ipo=tie, ';".;'A"for continuous
<br />monitoring, etc.)
<br />~ 0. 1'!!rere violations of pcnrrit requirements are rcpored, attach a h~cf exp~snet~nn to d_se~ibe cause and coTCCt~ve actions
<br />to be taken, and reference each violation by date.
<br />' 1. I."'no discharge" occurs during monitoring per,'od, en`s r "T`!o .^.'schc Le" a~•roes ~c ,r ~ ~ p'see c"d:'a crty.
<br />1Z. ?Inter "Nsrne/Titlr •.f P~irr„ip~l Fre.:rttir_ Gff:~r'• w'th "OJ,;;:~ ° ~e rj' : ri~~ •l~.,r F.rs;;•rl:~~ ~jji,:;r ~f ,:u1;n~r~ezJ
<br />Agznt, ""Telephone 1Vrnrbzr,"and "Doti" at bottom of form.
<br />13. A!ail s`~ ed 2cport to Office(s) by date(s) snecificd in ermit. Retain copy fn* yor ~ ":c:;-ds.
<br />t4. Mora detailed instructions for use of this Drsc;r~r~.: ,L,';;ritori:rg ,'2r~a: ('',:^il `c ~ i -y h. chtain:d from Oi*ce(s)
<br />specified in pemut.
<br />~:,~~~
<br />This report is rcquced by law (33 U.S.C. 131 ti; 40 C.P.R. 125.27). Failure to report or f lure to report truthfully can result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties net 1o exceed S25,000 per day of violation,
<br />or by imprisonment for not mote than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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