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Paperwork IIe,~~ucl~ion Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of ] 0 hours as an
<br />average pcr 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 far 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 that information already
<br />preprinted.
<br />2. Eoter "Per-mittee Nome/Mailing A~lress (and facility name location, if difFerent)," "Permit Numhzr," and "Discharge
<br />NumE~er" where indicated. (A sepazate form is required for each dschage.)
<br />3. Enter dates beginning and editing 'SYJonitoring Parted"covered by form where indicated.
<br />4. Eater each "Porarnetzr" as specified io monitoring requirements of permit.
<br />5. Enter "Sample A.9~asnrznrznt"data for each parameter under "~uautity" and ~hrolity" as specified i^ permit 'Avg"rad~" is
<br />norma]ly arithmetic average (geometric average for bacteria] pararrtctcts) of all sample measurements for each parameter
<br />obtained durng "rYl,nit%rirre Fwis ~"; "btninurar" and Ivfi.:irnur;t" arc normally e.~irem:, high and low measurements
<br />obtained during "rol•,nir, i,>,{ Fri:d". (Note to municipals wir~t sccondap• treatment requirement ~.nter 30-day average
<br />of oamtle m~asu-emcnLS under ",Iv~r~or,"and cater ma;imu~ 7-day average of ~amnlc measurements obtained during
<br />monitoring period under "M,uirnwn.")
<br />G. ~n:cam "P.'n.,it Rr; rirtrn~nr" for eaci~ parameter uuds' "[irvnri;~" ar.d "[irtJiN" as specified in pc'-rnit.
<br />7. under "A4. c:::" cri.:r number of sample mr,uurem^_nr during menito~;ng jr,:riod t1t.:.~LCed maximum (and/or minimum
<br />or ~-day average as appropriate) pc.'~mit requirement fur each parameter. If none, enter "0".
<br />g. ~.~,'._r "Fri., r.n.~' rf ~LuI)'s'1'" l:Lth .rs ".S r;n; L• 'iL.n'u _,~u;u" (aortal frcyu:ncy of sa~ap~inp, nod analysis uscr~. during
<br />monitoring pet~ud) and as "Permit fi=;uirrnum"specified in pc•mii[. (c. Entc~ ',.•.nr,"for con[ naoes n:uniloring, "i/7"
<br />for one day pcr wee';, "1/30" for one dny pcr munfn, "l,~90" for one day per qu.:r[er, etc.)
<br />9. Lntcr "Sr. n~ L T; F. "both as "5 ~r~y~!z i.l~.ra;u•aru,•t"(actual sample 4Pe used dud.:, rr.onlbnnb period) ant as "f d!nll!
<br />Fc:.•yan-_:;,,rs!," (e.g. Enter ";;rvP" for individual sample, "2sH::" for 24-hour composite, ".V/~;" far continuous
<br />monitoring, etc.)
<br />10. CJlruro t'iolrtions of permit rec;uircmcnts z!c rcponed, attach a beef c>.planaticn to ~cscribc cause and comc~ivc actions
<br />to be taken, and reference each violation by date,
<br />11. if"no ;iischargd' occurs during monitoring period, entryr "No Cischarge" eaoss Corm in place of data entq~.
<br />12. Enter "NamJTid: ,j frirr;;ipal Ea ~:u[ivz Gjf__r~" t~'idt "Sibrranrr: ej Fr%re_ii~ar' Es~_urire G~xr rf Autho,,iz,:d
<br />Ab.:nt. ""Tzl~~rh,ne A4unh„r, "and "Datz" at bottom of form.
<br />] 3. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />:S'. More detailed instructions for use of this Dis;:lmrgr rLl~niroring fZF~r-1 (G,bI/i) form may be obtained fmm O(licc(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is cc:quued 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 yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03!99)
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