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h~..~~~rwork Re~~:~,tion Act Notice <br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as a^ <br />average per response for some minor facilities, to 110 hours as an average pcr 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 inst7ttctions, searching 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 />C °neral Instructions <br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already <br />preprinted. <br />2. Enter "Per~rtittee Name/hfaifing /+ddress (and facility name/location, if different)," " Fennit Numher," and "Dis„harga <br />Numher" where indicated. (A separate form is required for each discharge.) <br />3. Enter dates beginning and editing ",~ionit~~ring Fzric.f"covered by form where indicated. <br />4. Eater cacti "Furamda=r" as specified in monitoring requirements of permit. <br />5. Cnter "San+rl=,1-L•isru~an,°nt" data for each parameter under "Loan/ih'"and Lualit) "as specifed in permit. "Avzrvee" is <br />normally arithmetic avcrEgc (gear-utric average Cor bacterial parameters) of all sample measurements for each Para*nc~:r <br />obtained dw ing "bfortir~~r;no f ~ri~ !'; ";bl~ziarum" and ,aisi„unu" arc normally extreme high and law measurements <br />obraincd durinb ".YLnit,rLtF F-risJ". Q+'rte to municip;us with secondary treatment recui-emenl.: Fnter 30-day average <br />of snmpla mcasurcmcnL: onricr "dr~r~~e," a~~d enter maximum 7-d:.y average of sample measurements obtained derittg <br />monitoring period under ";vlzrirnu;n.") <br />C:. Era_ "Pen;u! Fm; r•ir'smm:"for cad? par.-meter under "~r•~n+ih.,' and "~ualiq~" as s iceifcd in porn *. <br />7. Golfer ",ir ~ .t" en:~_* nonce, o'samplc m~..+urement during n-~uoitoring period iha' :xcud maximum (and/or mi ~i,num <br />or 7-day ;n u'cae ~s approprir(c) p:rroit requircmcut fur each paratncter. If none, enter "0". <br />g. _~~!_ "Fr:~r•:,r ; 'i,'r~l ~s" both rs "S_.. r; !_ .1•;_.rcrr, :,r~_..:" 'ual fre ue.ic•• of s'amp ing and analyss .?sad d.ains <br />. "J J~. t~_. 4 <br />;noniio;in~ peroc) and as "T.,'„ri! R.?erir:u~a~!"spceificu in pcm;it. (z.g. Fntcr "~onl,"fur cor4inuous mooitorino, "//7" <br />fe* age ~'y p: ~ tvc~::, "1/30" fo: one day ; cr month, 'Zr90"for one dny pcr quarter, etc.) <br />S. ~nL;r "S~c ,r !a 1}Fa" bunt e_ "S r.oF L• ;.~_ ,?,-~--nr ;r."(ecru. l camp's t~-p_ usrd durn~ r.?anitoring pcnod) end as "/'s~m;i! <br />Xsinirvn+,:rt." (e.g. Pntu "Grab" for indiviu_!;:I sample, '7-0!/:.'" for 24hour composite, '7r%1" far contiruous <br />monitoring, etc.) <br />10. 1'Jitere violations oF;-errnit requ' enenri arc i cponed, attach a Friel explanation to describe cr use and corrective ac:iuas <br />to be taken, and reference e<~ch violation by date. <br />I I. ?f"no Discharge" occws dung monitotino period, enter "No discharge" across form in place ofdata entry. <br />12. r.-;nlci "itram_/Ti/le %f rr;,r:;F~r P,a.rrtic_ !i~~_•r" tvittt "Sisnllur_ ~f Pria, i/~l F_re_zrriu; ~_'er of ~n!fr.rc:/ <br />fig.: ut, ""TeleFlr,nr A'umhn•, "and "Cara" at bottom of form. <br />13. \4ai1 si;ned Report to O~cc(s) by date(s) specifed in permit. Retain copy for your records. <br />14. ~1ore detailed insu-uctions for use of this Disrhargr Monitoring R:~rt (CeY1RJ form may be obtained from Otlice(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 violatio0. <br />or by imprisonment for no[ more than one year, or both. <br />EPA Form 3320-1 (Rev. 03/99) <br />