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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, 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 Affans, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregazd instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Perynittee Nome/Moiling A~lress (and facility name location, if different)," "Permit Number," and "Drscharge
<br />Number' where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Mrnitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sampler rvi-asuremart"data for each parameter under "Luantity"and Qe!uliy" as specified in pemit. Avzra~e" is
<br />normally arithmetic av~.age (geometric averege for bacterial parameters) o`all sam ile measurements for each parameter
<br />obtained dwing ";viavitorhrg P.:,i:d'; "i~lrimri,r" and hii:rrvum" are normally extreme high and low measwemenls
<br />ob~a+oed dur:ag ":~iLJI(L17di,' Pdii'.7". (Itiote YO mllnlelpEJs with secondary Ire«mcnt r..quircmcnt: °nter 3C da;+ avereSc
<br />o" ,aTplc mrasuromeits under "Avz,vbd,"and cute; ma::imum 7-dcy avn:rgc of s: mplc meas r:meot obtcined dun:-„
<br />monitoring period under "i/,z>;imum.")
<br />(7. Eric'O''C,i.li!R3;'~~,'_'i,7-_',7r"rOr ecCh paramMer under"~r(J.dihJ";nC'"~ih(i l}'"2c SpfCihC:i Sl r2rllt
<br />7. U~~ ::c: "N~, F~~" c; .. ~ ~.~~.~;Ler r,,"s~~nple measure^-,z i. iu,-ing moniuirn,^,_ .r ad i;ir: c. cxc *r^tiim ~.o (::oc'~,,r mini.: ~.
<br />or 7-. ay a~. er^gz a a,:i.ru;.,ial j pen~ft mquiremcrt for each parameter. if none, e~iter "~".
<br />II. '~nlrr "F.-:;a ~o_p cf."r_•rj;i." bn:h :. "5 ~,t'!_ iii ~lsore;,u.r!" (acicul f*cqu-acy cf ~ ~plin^ : ~d ar,:ysis used during
<br />mun~tcin~p'rod)ardas"Pr,,,'i1R_7.'i,~,,:_r!"specifi~dinpein~it(c.~.°uie;"., "fnrcun5nuo~~;moniioring,"1/7"
<br />fur c ~ ~ c;e per ciee';, "1/.IO"for one day ner month, "1/90" for one day per quarter, c's.)
<br />9. ?~'c: "__^~o, t~ T^i.~" S~t~i as "~.mt,-le i i vsnrern;o 1" (actual sample tyt~c t sod dur'r,; monitoring period) err ? as "^_•c+i1
<br />R_iri._m"~{" (-.g "Groh" for ~,:dividual sample, "14H::" fur 2n-hour c_mpcstte, '?'/A" :ur cec~'nuoas
<br />monitoring, etc.)
<br />tC. \'."'a,: v olrtiers u" emit ce_: emer's are r.i•ortcd, rlladi a brief exn!a~r.1'on to i cs_ribe cause <i:1 corr,clivu cot?one
<br />to be ia',cn, a-d reicrence each violation by date.
<br />11. ;. "uo c': •'~ -„ " oc_. ~ curing -~on~tu ink pcr:oa, e.~:~r "No DischsrSc" across fcnn i~~ alac.: o"da'c i-t.y.
<br />17.. -[nte 'S! o, t_,'~ ,;, .~' F, i,t_ipa! Fa~r_nlir~ ~~~..;." w'dt "Siow ~-rr, •z of Prin;: ii..1 Eza_zaivz :~ •ri cf .; m;;orea.'
<br />A~r;;t, ""T,;l ;~ho,rz h'n.,nbsr,"and "Dulz" at bottom of form.
<br />17. ~:a' ,;~a: ' :•, .• i ~~ :'""cz~s) by caters) specifed in permit Retain copy fur yom records.
<br />t' ' "urc ~tL•:i'.:? ~ns[:lc:funs far use c~ !his Gi:r;h~;gs ivi.nito.z:rg R:pa-i (Cf.TSJ fm~n may be o'..:{.,ed from C"c_''`
<br />,''.
<br />speci~icd in permit.
<br />~~~~T ~~ ~;Il~~
<br />This report is required by law (33 U.S.C. ]315; 40 C.F.R. 125.27). Failure to report or failure to report tmthful]y can r8suli 1-
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of vio:ati~
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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