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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vazy 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 "Pennittee Name/Moiling Address (and facility name location, if different)," " Parmi[ Number," and "Discharge
<br />Numhrr" where indicated. (A separate form is required for each discharge.)
<br />3. Eater dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requin:meots of pemut.
<br />5. Enter "SJmple M<asurement"data for each parameter ttnder "Qus+vity" and Qv~liry" as specified in permit. "Avz+uge" is
<br />normally arithmetic average (geometric 2vcrage far bacterial parameters) of all samnlc measurements for cacti parameter
<br />obtained during "Nluritorirrg Period'; "Ml;:iraro;r" and 1~S,:ia+um" a~~ nornially ea;rcme high and low measurements
<br />obtained during "Prf•,uitoriab Pa+zn,i". (Note to municipt's r:ith secondary trea7rent requirement: Lnter 30-day average
<br />of sample measurements under "Avz+vgr,"and cater raa~imvm 7-day avcrrge of sc-+plc measurement obteincd dnrag
<br />monitoring period under iLlaxi ,num.")
<br />u. Enter "Pen.-•i! Re,7ui. ~m~r!"for each pazametci undc- "~aurrtir~~•" a-d "~:r~liry" as specified in permit.
<br />7. Ur.rcr "T.r; °°" enter number of sample mczscreme.tt dung rnoniter,g .zr•nd the ` e-:a~ed m:.:cimi.n (acd';r minLcnr.i
<br />or 7- y sverage as appropriate) permit requircmeat far each pcrmc:er. If none, e..t_ "0".
<br />0. :'ntor "F,~;,uz,ry nj,:n~lysis" both es ",Ss„+taa i..`_~aua+n~':"' (achal frtiucacy of scmpGng and anarysis used during
<br />monitoring period) and as "Pecwrit Re7ui+rmtr,!"spccficd in permit. (e.g. °nter "':~.ur,"f.~-continuors menilorin~, "1/7"
<br />fog ono dzy per wec'.c, "1/30" for one day per month, '7/90" For ace day per quarter, e±c.)
<br />S. inter "SmnTl.r Type"bath as So+npla lAr_asure+,rsr!" ("r.,ual s,:mple typo rscd dm=ng monitoring pcriuc~ and as "Parris
<br />2yui:anre,u," (e.g. Enter "GruF" for individu~! sample, "24N~" fcr 24-hear composite, "T!/A° for contincous
<br />monitoring, etc.)
<br />'0. \'.nicr violations of permit rec;ui,-ements are reposed, att~dr a b:'ef e;:plana5oo to c':r.cribe cause and co~cTve actions
<br />to be ta!cen, and reference each violation by d:.te.
<br />11. If "no discharge" occurs during monitoring peried, enter "A'o P.'sclutrt;e" across form in place of data entry.
<br />l2.:inter "Na;xe/Titla of Pri,riPal F,~;:ullra G~~~.•r" ctah ".Sig,: i!u+2 cj (';inri; ..! ,^rs_uriv.r G~~~~r of dul5crized
<br />Agent, ""Telephone Nmnbar, "and "Gate" at bottom of form.
<br />13. Mail sued Report to Office(s) by date(s) specified in permit. Retain copy for your recorc's.
<br />Ih. Mare detailed instructions for use of :r is T.i.~.:h.n~ga .V.•,:,itrring Rer:rt (D;,~ fCTI mry be obtained from Cf.°ce(s)
<br />specified in permit.
<br />e
<br />71tis report is required by law (33 U.S.C. ] 318; 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 net to exceed $25,000 per day of violation,
<br />or by imprisonment for not more than oae yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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