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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 Ia~structions
<br />1. If form has been partially completed by preprinting, disregard instruction dvec[ed at entry of that information already
<br />Preprinted.
<br />2. Enter "Permittez Name/Mailing Address (and facility name location, if different)," "Permit Numher," and "Gischarge
<br />Numt~r" where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Perio_f"covered by form where indicated.
<br />4. Enter cacti 'Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sarrplz rYLasurznrent"data for each parameter under "~uanlity"and [iuali~}~" as specified in permit. iivarage"is
<br />normally arithmetic average (geometric average far buctcrial parameters) of all san-~ple measurements for each parameter
<br />obtained during ",'Gcnitsrina Fzrio.f"; "iifirim:rrr" and N;mimum" are normally extreme higt and lour rocasu~emcnts
<br />obtained dw-ing "i>ra~ifsring Fzri~;l". ("ore ;o municipcls with sccond~ry treatment -ceu=remcnt: rnl;. 30-dap average
<br />of sample mcasurem_ils uncle- "Avzr~ge,"a~;d onto rn~:imum 7-day overage ofsamp!e meas.rcments obtained dv~~
<br />monitoring period under "i~Jazinru:n.")
<br />6. Enter Pen:1,' ILquirzme.rl" for each parameter und_r "~uantitp"and "Quality"as specified in permit.
<br />7. Urdcr "h'•, ~;:" enter r ~rkcr of sami.:c mea evremu:i d~rin;; rcr,i.or ng period ~'_: c~cccd m:xirr.cm (~ ti'o~ rri^°- _m
<br />or 7-uay z~•cra~_ ra a;.; ropriate) permit rccuirmcnt for each. parameter. If none, enter "0".
<br />II. cotes "F: ~;; , ,:y cjr;.~ ~tysis" ua'h zs "°~~:~rL• Fl,. ~se.vrrtnt" (acwal "sceuency cf s~npling and a_:alysis ,rsed dori ~~
<br />^'onito;in~ period) an3 as "Fzrmit R7ui.,,,nr.v!"specified in pcrni:. (e.g. Enter "G~.a',"tor cant`n~ous monitoring, "I/7"
<br />for ore dad per wee:;, "//30"for cne day per monti?, "//90"for one day per quazter, etc.)
<br />9. °nier "Se•~;r~ I_ Ty/ e" Unlit as "S~~;rri_ , !_~surnrs;u" (ac[ua: sample Type used uurr.II mo utor'ng period) and as "Pznni~
<br />R_:/rrirant.ri," (e.g. C-ntcr "GrJi'" for individual sample, '14H::" fo:- 24-hoer composite, "Tt/.1" for continuo,
<br />monitoring, etc.)
<br />10. ~rMere ~%o'.. [ions of permit -cgeiremcnts :~e re,JOrlcd, attacb a hr~ef expIanat~on to dcecri ~c cause c:2d c~rrc: Svc art;enZ
<br />to be ta~ea, and reference each violation by date.
<br />1 I. If"no discSn ore" occu.-s awing monib,ing period, enter "A!o Dis=Large" across from in place efdata e~ty.
<br />]2. Cote: "Nu,rz/Tillz of Frir_iFa! E~;;_-u!iv~ G~juzr" v~iW "Signahu-a rf Prrc~t~t E~e.ertive G~-z; of At~lh~iri:_ I
<br />Agent, ""TzlzFhone NrunEar,"and "/.atd"at bottom of form.
<br />13. ;vigil .,igned Rcpoi i to C Tce(s) by date(s) specified in permit. Retain copy for your rocords.
<br />14, .'~lor de:ai'cd instructions for use of this Disch Deb. i.donitoring 2F•.r? tDrl~ fo:rn may be obtained fro :~ C(itcc(s)
<br />specified in permit.
<br />~~~~fl ~®L~ll~~
<br />'Phis report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure 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 year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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