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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 hotus as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 18 hoots 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 [hat information already
<br />Preprinted.
<br />2. Enter "Permiftee Nome/Mailing Address (and facility name/location, if different)," "Permit NumEer;' and "Discharge
<br />Numtzr' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitarirb Perial"covered by form where indicated.
<br />4. Enter each "Parameter" as speci(ed in monitoring requirements of permit.
<br />5. Enter "Sample Neasurzmsnt"data for each parameter under "quantity"and Qualit)~" as specified in permit. "Avzrage" is
<br />normally arithmetic average (geometric avcr2oe for bacterial parameters) of all sample measurements for each paramcicr
<br />obtained during "lil.nitorine F,rio,l'; "iJuinrum" and .Y;rnirnwn" are normally extreme high and ]aw measurements
<br />obtained during "L?,nir.rin~ F~ricJ". ('~o'.c to municipals wiih secandzry treatment rccuiremcnt: 3ntcr 30-day aaerr;;~~
<br />of sample measurements LLnde- 'Avenugz,"and enter r1a.i,num 7-clay avc~gc o'sample mczsuremcnts obtained d~_r'-.g
<br />monitoring period under "Ivazimt:m.")
<br />6. L-n;cr "Fzr:7it Re~p~iremznr" for each ; arame:cr unds "~m~ntit)~"and "~Jvality"as spcciricci in permit.
<br />7. Uadc- "i•k. F.'" entryr .:;abet ^'>•snp:e m:asu;emcct c:.i,-ing mcni:o-leg perod ths'. c. ceed ma:,imv, n (a,:;.; mi .' n
<br />or 7-day aver,,, as a-,prep ;aye) ~ennii reeuir;,mcnt for each pm~ameter. If~One, entry "0".
<br />8. Enter "Frzgru~:_y of ~:. r;~sis" bah as "S_n;-,1'L i;;_sr,~_ru,r " (actual frcquenc~ of sampltag and aoai~sis oscd duric~
<br />ronitoring period) and as "Fe.:r.;. 2.nri,~~,rvui"specific, in penal.. (e.g. Lntar "Gone,"f0; conti,ruous ,roni(oring, "1/7"
<br />Cur one day per wee!:, "1/?0" for cce day pa monrii, "[/90" far one day per yuaricr, etc.)
<br />9. Este: "°u.rpts Type'^ oth as "SamE1e :i-i,:~aur~n:_nl" (actual sc-ip:e Type used dureg monitorng period) end as "Fe;,;rii
<br />R__lub•rmant," (e.g. ?nter "Groh" for i_idividual sau~p:c, "Zdl/G" fo- 24-hour composite, ",\r/A" for continuo"
<br />monitoring, etc.)
<br />10. A'acrc ro:;niuns o"pcrmil requi,-cmcois a ~ reported, at~ad: a i:.iefe::pl:..~a[ion to describe cause rnd co:-rective cct~:.ns
<br />to be taken, and reference each violation by date.
<br />11. i f "no discharge" occurs dw-ing rroritoring per,'od, enter "D`c Ducharge" across Tan i„ place of data enemy.
<br />12. Enter "Naraz/Tiilz of Frincipst E:,z_utiv~ !'~_'r-" vritlt "Sio~eJlvr~ , j Frirr_it ~! Exzc2diva Gffieer of f!tsrlro,-i~zJ
<br />Agenl, ""Tefzpl7are Nrrmba; "and 'Gertz" a[ bottom of forth.
<br />] 3. Iv;ail signed Report to C~Ttc;,(s) by date(s) specified in permit. Retain copy for your records.
<br />I '.'.4ore detailed instructions for use of this Dis.:4ore.: i.Jonitoring 2psr1 (Div~Rf fe.,n may be ob:~iined from Cffic:,(s)
<br />speci 5ed in permit.
<br />ILe~afl N~tIlCe
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or Cailure to report truthfully can result ir.
<br />civil penalties not to exceed 510,000 per day of violation; or in criminal penalties no[ to exceed 525,000 per day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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