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~a~erwork 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, 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 farm has been partially completed by preprinting, disregazd instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permiltee Name/Moiling Address (and facility nameAocation, if different)," " Perntil Number," and "Discharge
<br />Number' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "ivloniloritrg Period" covered by form where indicated.
<br />4. Enter each 'Parameter" as specified in monitoring requirements of permit.
<br />S. Enter "SamFle Me,zruremerrt"data for each parameter undo "Qulutity"and Quality"as specified in permit iiverage" is
<br />normally arithmetic average (geometric average far bacterial parameters) of all sample measurements for each parameter
<br />obained during "dAoniroring Period"; ";•.f~rinurr" and rLiininuwr" are normally extreme high and low measurements
<br />obtained during "i!5Gn!l ~1'Lr~ F'drRO.f". (Note to municip; is c~~illr secondan,~ lreatmeat -equ~rement: inter 30-day average
<br />of sample measurem:,nts unde.- "Ave~-~xge "and entry m~ximurn 7-day average of s~mi+le measurements obtained dung
<br />monitoring period under "it4azimurn.")
<br />6. Enb-; "Penrrit Rrlu%razrear"for each parameter under "Qumr'iry"and "Quality"as specified in permit
<br />7. monde "/\'v Fi' cntei number o'sa ~p:c ~rcascr..:nnu cu.in~ r..ori:oring ~~*iod t::..t c:.cccd maximum (rnd.'or mini *_.m
<br />or 7-lay avcmoc as appropriate) permit requirement fir each parameter. If none, enter "0".
<br />8. £n[ur "F, ~~u.,r_y of fn.eJysis" bath as "SanrFlr ;:ie~esr~r~rrant" (aat~al ucqucncy cf rampling and ana'ysis used during
<br />mon~~tcring pc;iod) and as "Fzr,nit Requi,-~.azut"spccfied in p_rmit. (e.g. Enter "~~.rrr,"for continuous monitoring, "1 /7"
<br />:or one r;ay per wec!c, "1/30" for ose day per mocff~, "1/90" for one day per quarter, eteJ
<br />9. °nter "Sa;,rFl ~ T,•+~="both as "Sample iilsasw srrsnr" (acwal s~~nple :ype used during monitoring period) and as "Pernri!
<br />2:lviremaut," (e.g. Lnter "Grate" for individcal s~aplc, "1dH~" for 24hou- composite, "N/A" for continuous
<br />monitoring, etc.)
<br />]0. R~terz vio:atians o. permit requirements are rcporie;;, c[acb a b,ie~ explanation to describe cause and corrective actions
<br />b be ta'.cen, and reference each violation by date.
<br />11. ~ ~ "no discharge" occurs during monitoring period, enter "A:c Discharge" cctoss fm ~ in pl~cc of data enUy.
<br />1Z. Enter '7Vam~~/Tide cf PrirrciFal Exeartiv~ OJfi_ar" rriih "S%gr,%arr~ rj P;inc•~~ ~! E:a~zrtive Cfficar of Authored
<br />Agsnl,""TelcFftcn~Number,"and "Date"at bottom o. form.
<br />13. 'pia:' ;igaed Report to Cwce(s) by date{s) specified in permit. Retain copy for yow• records.
<br />l~. `~`oro de:ci'cd ~rstruciions ;or use of Gtiis Gischl,-a~ ,>i~„ritorirro R.tF;,t (G,;•,RJ fe-m roay be obained G-om Offices)
<br />speci ~ icd in permit.
<br />
<br />Tlris report is required bylaw (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can result in
<br />civil penalties no[ 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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