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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 horus 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, 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, disregazd instruction directed at entry of that information already <br />preprinted. <br />2. Enter "Permittee Name/Mailing Address (and facility name location, if different)," "Permit Number," and "Discharge <br />Numhet" where indicated. (A separate form is required for each discharge.) <br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated. <br />4. Enter each "Parameter" as specified in monitoring requirements of permit. <br />5. L•nter 'Sanple Meosunment"data for each parameter under "quantity" and Qualih+" as specified in permit "Average" is <br />normally arithmetic average (geometric average inr bacteria] parameters) of all saTplc measurements for each parameter <br />obtained during ";d,nitsring Fe;~io~.f"; ";iluimrnn" and ~L:miunna" are normally ecLeme high and low measw cmanls <br />obtained during ,v;arit--.ring Perioj". (~rotc ;u runicpals vriin serond~ry trestmcnt requirement: Ente- 30-day average <br />of sa+nplc measurements unde- 'hv~rage,"aad enter ra~dmum 7-r;~y average o; sample measurements obtained durng <br />monitoring period under "Ivaximum.") <br />6. Enter "Penvi! Regoiranen!" for each parrreter under "~rrmrrty" an[ "~h~ality" as specified in permit. <br />7. Uadcr "A'v r'.;" enter number of sample measuremcrd C~-ico ~ncrit ~rng pet:-iod ihc, e:.eecd maximum (and/o* mir.i;um <br />or 7-day averab,: as appropriate) permit reeui•cmer.t :ur each parzmclc-. 1; none, enter "0". <br />0. Enter "F,..p~ a,_y cf f:%+~!ysis" b~1+ as "S_~r,+F!s ..v ~sr~ _r. a, " (ccma] Gequcn_y of sampling and analysis used durnU <br />;.-On ItCRRg j.UrlOd) and a5 "P1rrJ 1! Re ftu; _ar1Jl" SpCC'il L'd in ~ ^rn'1. -. (C~. ~ ":[ "/ini," u4 COnL~RLOllS mOnltnrVlo, "//~" <br />for one day per week, "1/30" for enc day par mono, "//90" for one day per quarter, ctcJ <br />S. Sato "Se,;:;-/: TjTe" I:olh as "5~;.+t k iv-':arrn-e+,.ar!" (cc:ual z-~p'c type used dur ~:g monitoring period) and as "Pa-rrit <br />k~yni;~~ment," (e.g. Enter "Gr~F" for iodividaal sr.nple, "2^//~° for 24-hour ccmposite, 'i\r/A" for continuous <br />monitoring, etc.) <br />10. '~`~nCre viclatiuns of pernit requirements c:C repnried, £LaCh a u. P~C'Lp1F r.%ct10n is dcsGii JC Cause a.~d cOrrC(iivc actiuns <br />Io be taken, and reference each violation by date. <br />11. ; r "ro discharge" occurs during monitorng period, enter "i!e Discl•aroe" across form in plane u. data entry. <br />IZ- Enter "Narre/Tii!e r,J Pri+r_iFa! E'xe:utiv~ C.~ •. r" cnui 'Siona!;a~s aj Prdrr:if_J !'se.r!live Geer of Aurhoria~d <br />Agent, ""Te!ephnrr N+mrtar,"and "Getz" at bottom of form. <br />13. :uai; signed P.eport to Ci+rce(s) by date(s) specified in pc.~,:it. Rctcio copy "a-your rocords. <br />.. "u*.: dcir.itcd instructions for use of this Discharge ;i,niro,ino H.~F~,rf (DinRJ fo:,n may be obi<ined Gam C1Ticc(s) <br />specified in permit. <br />e <br />~~~~ ~Ta~--i"~ <br />This repot is required bylaw (33 U.S.C. ]318; 40 C.P.R. 125.27). Failure to report or failure [o 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 ooe year, or both. <br />)/PA Form 3320-1 (Rev. 03/99) <br />