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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 ] 0 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 Protectio^ 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 akeady
<br />preprinted.
<br />2. Enter "Permittee Nan:e/Moi/ing Address (and facility name/location, if different)," "Permit Number," and "Discharge
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Morrit.ring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "S~mp/e Measurement" data for each parameter under "Quanliry"and Qualir)," as specified in permit 'Averogz" is
<br />normally arithmetic avc ~gc (geometric average for bacterial parameters) of all sample measurements for each parameter
<br />obtained daring "b;cnitoriug P~+-iod'; "d;r:inun:," and Mi:u;:nnn" arc normally extreme high and law mcasurcmzr`s
<br />abtaincd during "i.f~,ritrring Pe,io!". T;a:c to municipals midi secondary trcatrscat ,~quircment: Enter 30-day aver~~e
<br />of sample mcasuremcnt_c undr ".?vzr.~r,"and c.mtcr maximum 7-day average of sr~ple measurements obtained darng
<br />monitoring period under "Maximum.")
<br />G. Enter "Pa-mi! 2?L[IYii3C,1t"for each parameter under "Qva+Uily" ~-md "Quality" as specified in parntit.
<br />7. Urne* "pry, F':" e*•to- m~mbcr of s~-nhle mcasure~r.c~t during moniteriv~ period ilrat ezeeed maxinv_n (a~u;'or mini-;., r~
<br />or 7-day average as a;~,~ropriate) per,-tit rcquiranc~;t`ar each parameter. it none, c.~tcr "0".
<br />8. ?.ntcr "Fr~q+ea.y ~ f; ,r ~lysis" both as':""a;.ls 7;-,s,v-ar,znr" (zcwa! frcauzncy of s-s,pling aad rna]ysis used durin;;
<br />roonito.ing pcriac`, ar.3 as';°er,:tit R leri.z.++e~:'" spac:feed in pcrrnit. (c.,",. Cntcr "..^.oal,"fac cantinuomu monitoring, "//7"
<br />for one day per wee!:, "1/30" for one day per month, '7/90" far one day per quarter, etc.)
<br />9. Crater "Sa~+;,r,/~ 7;,p."both as '(S_•:,r~k ; 1 ~.~sr~rt.,:a ~" (aMual sampl;, type used during monitoring periad) and as "1'~;;ait
<br />2?ui,•ernsu," (e.g. 'inter "G.vY' for i;,dividual sample, "241/C" far 24-hour composite, 'N/A" far cantinucns
<br />monitoring, etc.)
<br />'.0. P.nmerc, violations of permit ,-equi-ements c-c rper'ed; attech a brief e;:planat on to describe cause and eorreetive actions
<br />to be taken, and reference each violation by date.
<br />I I. If "no discharge" occv.rs during monito-ing period, en±er "Nn Cischargc" across fcrm in place of data entry.
<br />12. Crater "Nwne/Title of /'ri:r„ip.r( 1'ie,::ui~ s G~_e:" with "Sib,+at.o•c ~.f Friru•;r~l 6x~~zrtive Cffi~er of A¢!;ro+iz,t„(
<br />Agent, ""Telephone Numhar,"aad "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by ~tc(s) specified in permit. Retain copy for your records.
<br />14. A,iaro detailed instructions for use c`this Dischar^' :N.•,ni!ori::S .Rr~.+4 (Glv1~ form may be obtained frcm CfEcc(s)
<br />specified in permit. u
<br />L:vJC it ~~C~i:~C'~'
<br />This report is required bylaw (33 U.S.C. 1316; 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 yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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