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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 houus 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 instmction duected at entry of that information aUeady
<br />Preprinted.
<br />2. Enter "Pennit[ez Name/Moiling Address (and facility name location, if different)," " Permit Number," and "Discharge
<br />Number" where indicated. (A separate form is required for each dischazge.)
<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. Enter "S~mple Mearurzmen!" data for each parameter under "Qua»!ity"and [irrslity" as specified in permit. "Average" is
<br />oc~nally arithmetic average (geometric ave.-ge for ~actcrial parameters) of all saorplc measurements for each parameter
<br />ob:aincd during "r14.»irorhrg P2r-iod'; "hAr:ir,»~n" :nd Minirnun" arc normaL'y exteme hip~~ and low measurements
<br />obta:ned dining "lA;:rir~„ ing Paris". ^Vote to munici .Js wit,5 secondary :reatmcnt r_ouiremcnt: Enter 30-day avera~:
<br />of samplo measurements under "Avz-~g~,"and cater raximt-n 7-:>vy average of sample mcas~ucmcnts obtained dt.r,ng
<br />monitoring period under "ivuximum.")
<br />6. Enter "Per,.-i! IZ~~ui,~euv~:rr" far each parame:c, under "~.u:nlity": ~d "~h~al!ly" as specified in pernut.
<br />7. Unger "Dt ~ E:" c:•.e~ number of sasnplc ~r, _csm _rrn' dump, mot an,iog :_r.od th r' • .recd mscinnm (au~'o- mini;r.rm
<br />or 7-day avarage as ap~ro ~riat.:) pern't rca;iiremcrt fcr caclr aarcmGc,: I('ocnc, e rtcr "0".
<br />3. '?.itar "F', ~;va><y of /'n:-!ysis" Beth as "S_,grl~ ,l-'• ~.c „ -,,... " (:.ctta' Cr;ucncy of se.npl'ng anti aoa~ysis used during
<br />monitoring period) acd as "Pt,-.;;it 2;.~ir,,ae:N" soc. iGcd it ;x: niit. (;.g. Enter ",. „d "for continuous monitoring, "!/7"
<br />for one day per week, "//30"for one day per monti~, "!/70" for ono day per quarter, etc.)
<br />~. ante. "S1ai~.L• TyFe" So6r as "Sl.u~l.: L. ~~~~r. a,odr ~" (.dual sample tyre ~scd dw-:a, monitoring period) any as "P~~,rrit
<br />Rz7ui,ament," (a.g. F,n:^r "Grsb" for indiri:v_ ramplc, "2•?!/G" `or 24-hcur canpositc, "N/~1" for continuous
<br />monitoring, etc.)
<br />r0. C^rere violations of n;,?mit retji~i-eraer.r_c are -,.ores, attac;r a beef c,;pL~nation to describe cause and corrective actions
<br />to be taken, and reference each violation by dzte.
<br />1 I. If "no discharge" occurs during monitcrin~ p~~=od, e~':r "i:o C'srl ,rgc"across form in place of data tntry.
<br />12. Enter "Na,nJTitL• cf 1',-i;roya! Cx~°~aGt_ Gf_.,~" v;iS ".Ci;;nst.:r~ ~f !'rLr.!rll rtt~alivt Gf/i,;zr of .futhorizzc/
<br />tiganr, ""TelepJecne Number, "and "Date " at bottom of fo. gin.
<br />13. Mail signed Report to Offiee(s) by d~tc(s) recif ~d i.. permit. fetain copy far your records.
<br />?4. DQore detailed instructions for use of tins Disc:f_,~~ lv,'~.;;i!:ri,rg R;T~,T (Cd,'T~ fore may ba obtained frcm Office(s)
<br />specified in permit. ~'
<br />W11~+~ W W
<br />T1~is report is requmed by law (33 U.S.C. 1313; 40 C.°.R. 125.27). Failure [o report or failure to report truthfully can result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criruinal 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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