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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 hours as an average per response for some major
<br />facilities, with G weighted average for major and minor facilities of 18 hotus per response, including time for
<br />reviewing instructions, 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. Environmenta] 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, disregazd instruction directed at entry of that information already
<br />Preprinted.
<br />2. Enter "Permitlee Name/Mailing Addrrss (and facility name location, if different)," " Permi! Numbar," and "Discltotge
<br />NumEer" where indicated. (A separate form is required for each dischazge.)
<br />3. Eater dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Param~l~ r" as specified i^ monitoring requirements of permit.
<br />5. Enter "Ssm~ e Ad_asursm~ra" data for each parameter under "Qrrvrtity"and Qtraliry~" as specified in permit 'Aver.rge" Ls
<br />nornally aithmetic average (geometric average for bacteria] parameters) of all sample measurements for each pararnclcr
<br />obtained during ":i4~,nia:rirt6 F~°ri,d'; "i~li±imum" and llfiuinrzart" are normallp extreme high and low mcasuroment,
<br />obWincd during ",4/.uir,ring p~ricd". (T~cte to municipals with secondary lrualmurt ryuircmcnt Fnter 30-day a~uragc
<br />of k~mplc -ncasnrements under "Averted -,"and enter maximum 7-ciay zvei~ge of samj,le measurements obtained during
<br />monitoring period under '7vbaxinnrm.")
<br />6. En:: r "Frr,ni! fZ.•?uiramant"far each parameter under "LumlJy"and "~rro{i.ry" as sprci f fed in permit.
<br />7. Under "tVv rc" enter number o~ sample m~asuren,cnt dwin~ mnritunn;; j;:ricd tl;a( c.~cced maxinum (and/or minimum
<br />OI" I-day aVt;r3e`C as appropriate) pennii requirement frn- each parameter. ?f none, enter ".7"
<br />8. 1:n'.c "h'rv,w_,~^,, oJArr~Ipsis" botS as 'B~rn~ la b,'_~uur~~ner.!" ;a=hal Gcqu.ncy of st:mpling rod analysis :!scd dw-ing
<br />nioniioriug period) anu as "F~nnit Fe ~_7rri, :-m cur"specified in per.nit. (c.g. Ente: "~;nl,"far continuous nionitori>_)„ '7/i"
<br />for ane day per roc;, "I /30"for u,te day per month, "IJ90"for mre day per quartet, etc.)
<br />4. f n::r "Sarrf•L T T °.. both as "S~n,f!..-; ~~tsurear -,:r" (maual sampic q~pe used during n;onituring pcriad} end as ~~ °rrnr~r
<br />R.~uirenr.:,./." (e.o. r~~cr "(;,-et" for individual sarnp!e, "2di/;:" for 24-hour composite, '517'" Gar con inuous
<br />monitoring, etc.)
<br />10. ~.1~rCCC 'J:OIa[InnS Of pernnt :CgatfementS 3*l' repOrled, attach a brief u:;plarrztion to describe cause and cor:ECtive ac ions
<br />to be taken, and reference each vioiatio^ by date.
<br />11. 1f"no discharge" occurs during monitoring period, eoter'T:o Discharge" across faun in place of data entry.
<br />12. Enter "IJa~aJTilh_ of TrinciEar F.A:_Ul(lY G~__•r" with "Signah.r: cj Fruuir.,r F_xe_xdir: GJji_er of Arriho.-i::e:{
<br />Abort, ""T~leFh•.us tVtunha•,"aod "Data"at bottom of Form.
<br />13. 1~Iail sibmcd Report to OfEce(s) by date(s) specified in permit. Retain copy for your records.
<br />]4. 'viore detailed instructions for use of dris Cis~harga tLfonitorhrg Rrot7 (G,lfh) form may be obtained from OFfice(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 yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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