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~'aperwork Re~~ ~~.oo. Act Notice
<br />Public reporting burden for this collection of informaton is estimated to vary from a range of ] 0 houus 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 pcr 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 />Chie ;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 Affair, 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. Enter "Permi[[ee Name/Mailing AdJr•~ss (and facility name location, if different);' "Permit Number," and "Disch~rga
<br />Numbar" where indicated. (A sepazate form is required For each discharge.)
<br />3. Enter dates beginning and editing "ivlonitoring F~rio,/"covered by form where indicated.
<br />4. Enter each "Poramz!er" as specified in monitoring requirements of permit.
<br />;. Lnter "S~nq.l~ rLLis«r-runt"data for each parameter under "Quontir)~"and Qualit}'" as specified in permit. "Av~,,~,; ~" is
<br />uonnelly a~ithmelic average (gcometic avcruge for bacterial parameters) of all sample mezsurcmenis for each parameter
<br />outained during ",LF ni!:rin;; 1 dri~J"; ".'vlrcbnum" and lvlirrmmn" are norntally , n'cme high and low measureinect;
<br />ohtainc~: during ',.(~,nir rind F:ri;!". (Note to municipals ~:itl, seccndary treannent rqui-emenc 3ntcr 30-day :.vcregc
<br />of sa~i~o'e me~suremenls under "fiv~;-l~; e,"and enter mexinum 7-da}~ average of sen-~; d;. mca_sur„m.nts obtained dying
<br />monitoring period under '?v:,zximum.")
<br />v. :-:ntc r "i rmri! R.'/v%r,nrs,:r" for each parameter undo "~;tnr!ih~"and "ws!i!~~" as s; :cified in per i:.
<br />%. Unde, "i:' !'r" enter ^umScr of sample mea:uremen; During murrt,,n~~ Senn[ t'~~.r; c~.eeed maximum (gin?/'nr min~n,um
<br />0 7-dzy avc~agc as cppro;~riate) p;:mil r.:quS-emcnl for each parameter. 1f son.:, enter "0".
<br />8. 'a!tc- "Pr~;r,_,up ~JAr;~lrvic" l-~a11t :, "S..•., I• 'vla,r~m~_o, -,r;,' (acttzl f:eyltul y n` =a~npling ar.d analysis rscd during
<br />mun;ionng perod) and as "F.•~.nir Rz;ui,~;:~:nr"specified in ra~ni~. (e.g. I-];!ci ' .•,nl,"far co^tirueus muniturinL, "1/7"
<br />f•.~, one c ay pcr ucck, "1/jll" fn mt~ dzy per ironth, "1i90" for one day pcr quarto, etc.)
<br />S. Fnt.x "e :nrlk ';~ ~" imth as "S. ~„rFl: ,4; •_n ur_.:~ ~rt~" (actual san:plc type used during mun'.torin~ pcried) zrc: zs "F'-, ;,rN
<br />Fi,:~uir~ur_n[," (c.y. I:ntc: ",rah" for individual sample, "74N~" fcr 24-i»ur composite, ",~Y.:" fur cmi •r.uuus
<br />moniWring, etc.)
<br />10. e,n,,se violations of permit requiremens zrc reported, attach a b~icf e:aplanation to dusciibc cause and wrcctivc aetiea.,
<br />to be taL•cn, and reference each violation by dale.
<br />I 1. If "nc discLzrgc" occurs doing monitoring period, enter "No Dir,eharg_" across form ut place of date envy.
<br />12. Enter "N_~nx/Ti!l. ~j Frincipat Erz.-ufire ~(Ci s" with "Sibn~!ur= of Pr•h,;F.,t Es.:7r!iv_ C~_~r of Avdr..~i-.:J
<br />Ab,:n[, ""Talorh~ns >\RunL r~, "and "D11,:" at bottom of (orm.
<br />13. A4ail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this C.rs:hlre~ M,rtirnrinb R_-r•.r! (L'd~/R) form may be obtained from Cff ice(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 />ar by imprisonment for not more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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