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Paperwork Reduction Act Notice
<br />Public reporting burden For this collection of inforrnatioo is estimated to vary from a range of 10 hours u an
<br />aversge per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 16 hours per response, including time for reviewing
<br />instructions, searching exisimg 2ata sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of information, includin;; suggestions fur reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of information and Regulatory Affairs, Office of i,tanagement and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. if form has been partially compl•;red by p;ep,inling, di;regazd instructions directed at entry of that information
<br />aUeady preprinted.
<br />2. Enter 'Permiltee h'an;e:UarYng Ari~ress (and facili,y name location, if t1iH'erent)," "Permit .Number," and
<br />"Piseharge,Number" ufierc irc!icatcd. (.A separate form is required for each discharge.)
<br />3. Enter dates beginning and cnd;ug ';t;,vritorrng Peri~<•"'to~cred by form where indicated.
<br />4. Enter each "Parameter" ;u spcc:ficd ir, momtorng re.~ui: ~ments of permit.
<br />5. Ecicr ".Srn,:ple ,4:ea.vremcnr" ;l:::a for each pa:amr;t•t a ,der "Quantity" and "Qrm6(v" in units specified in permit.
<br />"Ace-„g2" is normally atitlmu .c avenoc (gcortMrc :;ti.,:ragc for bacterial aarame!ers) of all sample measurements
<br />for each parameter eb!ai~+ed during ". !, •nL'nnng Rru,.', "Afa;imurd' and "dlinirnurn" are normally extreme high
<br />and low measurement obttircd Giu,ng ".tlon~t:,:r,y, °r~iud" (Note tc municipals with secondary treatment
<br />requirement. Enter 30-dn~ neerabe o' s~mplc n~casutccients under "Averoge," and enter maximum 7-day average
<br />of sample mcasurem:ents obtarrcd durn~ monilorin~ p.:r.od under "blarimnrn.
<br />G. Enter "Permit Rrquv.ment" for c+c'.t furrmctcr under "Quantity" and "Quc'ity" as specified in permit.
<br />~. Under "i/o Fi" enter nu:nbcr of ;:r-n~plc meaa:rm~ats during monitoring; period that exceed maximum (and/or
<br />minimum or ;-day avera~c as appropnatcj xrmit requirement for each parvneter If none, enter "0".
<br />8. Enter "Frequency ~,~Arn/r,u" bo;h as "S1nrpA• .1ceo. urrnent" (actual Cr~quency of sampling and analysis used
<br />during monitoring penodl znG as 'Pe~;,,n .Regvirerne;d' specified in perniit. (c g., Enter "Goof," (or continuous
<br />monitoring, "//7" fur one flay per e"'ck, "i 30" for one d:} per mouth, "!i9r"' for one day per quarter, etc.)
<br />9. Enter "Sample Tvpe" both as ' ~cnrnle ,tdeosurement" (ac~;ral sample type used during monitoring period) and as
<br />"Permit peguirement," (cg, Enter "CCrch" fn+ individual sariple. 'rlJ;lr" for 2d-hour composite, "N'A" for
<br />continuous monitoring, etc )
<br />10. Where violaUOns of pern~.t rr ui~emr yr arc repor_d, .•4ach a brief cxplanalion to describe cause and corective
<br />actions taken, and referen.: c::-h °,nlaaen by d~ttc.
<br />11. If "no discharge" r>L-curs during mor.i~^in~ perio-i, enter ".1'o Discharge" ac-oss form in place of data entry.
<br />12. Enter ",Name~TiUe njPrmcipui E;rear'S ° U,~j•~'r" t;tfh ".Signnrure .,jPr~acipnl Executive OJTcer ajAuthorized
<br />.4gent," "Telephare Numb: r," a,td "Dare" ar bol~om cf form.
<br />13. R4ail signed Report to Ofl:a(s) by da~ci s. s~eciLcd in permit. Retain copy for your rceords.
<br />14. More detailed instr etion~ for ,Se .,; rh•s lA.ccwor~>r L1on,toring Report (/1A;R) form mad be obtained from Office(s)
<br />specified in permit
<br />Legal P~otice
<br />'ILis report is required by law (?3 U ;i. C. rs 18; 40 C.r.P. I':5.27t. Failure W : ;port or failure [o report truthfully cm
<br />result in civil peualties not to rxcn i s,10,0^n aer day of vrrlanau; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for nit msr° roan one year, or by both.
<br />EPA Forn 3320-t (iicv. On-95)
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