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~a~er~vorl~ ~.~~'°.~~~ion Act Notice
<br />I 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 nezded, 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 preprutting, disregard instruction directed at entry of that information aUeady
<br />Preprinted.
<br />2. Enter "P,~rmrttee hJme/M,ziling A,1,irzss (and facility name location, if different)," "Permit NumGer," and "Discharge
<br />Numt+er" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "M~nitoring F'erio,~" covered by form where indicated.
<br />4. Enter each "Paramata•" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Measrn~emart"data for each parameter under "~uantiry~"and Qu~iity" as specified in permit. "Are r~g_=" is
<br />na; malty aithmetic average (geometric av,rage for bacterial parameters) of alt sample measuremenLc for each parameter
<br />obtained dw-ing ",Lfonilorin~ Ptri,/'; ",Lhrirn nn" and A/inimum" arc normally extreme high and luw measurements
<br />obtained dtn-i~g "bir,;;ir;rinx Fari•.1". (TJote to municipals with secondary treatment rcyuircmenC ~ntcr 30-day average
<br />of sample measurements nndcr "~1v~,?.;d,"a-d color mzximmn 7-day average of sample measurements obL~ined durirg
<br />monitoring period under "Nfaziuvunr.")
<br />5. ;;ets,- "Pz~rit Re?uiraurnt"for each parameter under "~'umri~r"nnd "[huldy"as specified in pear;:.
<br />7. Under "i~, Fs" enter number of sam, lc mcasuramcnt d~~ring r, onitoring period ;'.:t _ :c_cd ma;:imum (nrd'cr min murn
<br />or 7 dry ave ~~= as ;.;~propriate) permit requirement far each pammetcr. If nuns, ccter "0".
<br />8. L-n;er ".+•'rzir:.. 7, %,f~Lulr~ss"both as "O_~,•.~rr.C• 4: vS~. t;7;J;rr" (ac;u, l f-ecuenc~ ~,"sampling srd avaly::is used ~ urnr~
<br />moot wring pcr~od) end a,"P_r„rir Rr.;vu•~+r;?,r'.,nccifcd in permit. (c.g. f rater '^-:ul,"far conli~;uo~.s menitorin~ "!/7"
<br />fcr one d .y ~:: v.~.:el:, "1/30" for one day per m. oth, "1/90" for one dray p„r yuaner, i lc.)
<br />^. 1?nizi ",;.rat L Typ e" hots ~, ",S.+;rple .'.1~~•:a. _•r.uo!" (actual sample type u;~rd wring ntor.itoring perod) and as ""_•n,ri!
<br />R~~7uirror~er," (c.g. t;ntcr "GraF" for individttal sample, "?dH.:" fcr 2¢bair compnsi'~e, 'SV/A" far cortir:cous
<br />monitoring, etc.)
<br />1 C. `;lhae tzolatitns of pemrit requirements are -c^ortcd, aGaeh a brief explanation to describe caesc .:.nc; corrcaive actions
<br />to be taken, and reference each violation by date
<br />1 I. if "no discharge' occurs during monitoring petiud, rntcr "No Discharge" across form in place cf data entry.
<br />12. F,nter "N~m/Titla cf I'rin.;ira( Fr;:utir_ G~ .'r" with "Srb~ranu•_ Gf Prin.iFsr F'rrzuiv_ O]~~~~:• of Atr!i~~.ria~J
<br />~Igenr, ""TelepL~~nz Rhnnhtr,"and "Cats"at bottom of form
<br />13. Mail signed Report to O1Ticc(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this f^s,:3arg~ b9onit,rind Rep~,rt (C;r1X1 loon may he obtained from O tf"rce(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (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 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 year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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