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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 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 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 Protectio^ Agency, 401 M Street, S.W.
<br />Washington, DC 204b0; 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 dvected at entry of [hat information already
<br />preprinted.
<br />2. Enter "P2rnriflee Name/Mailing Addrzss (and facility narnellocation, if different)," " Farmi! Numbsr;' and "Gis~h~rgr
<br />Numhar' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Moniroring F~riG.l"covered by form where indicated.
<br />4. Enter each Faramrr'r" as specified in monitoring requirements of permit.
<br />5. L-nts ".SJi.q(11 i6lJS20'JA7.91!" data for etch parameter under "~uJrrtilt'"ar.d [ieralit}'" as specified in permit. 'Ac~rJe•s" is
<br />normally a.-ithmelic average (ocumetric average for bactzrial parameter>) of all sample measurumenis for each parxnelcr
<br />obtained durito "iv1 rrihrino Pdrisl'; ".VJairnunr" and ;./iuinrum" arc norrnal!y c~trcmc high and low measurment~
<br />obt<inri dt.~ng ".bL~nir„~irg ^_r-i~?". (Note to mtmicipals rait!t secondzry treatment rcqui:ement: Enter 30-day average
<br />oP s: mplc mcaswemcros nicer "rit~sragz,"and enter maximu.n 7-day ave2~e of sample measurements obtained during
<br />monitoring period under ",Llaximurr.")
<br />G. Er cr "F~n;%it !~•:lr•irnn_ut" far each parameter under "LVJrrin,"and ".;7reo(ily~" as specified in perma
<br />7. U~~der "Ar< i:~:" enter num::er o"sample m~~_~uremcn[ during monitoring per.ad tha: etcceC mati~mum (:,.no/or mi,rl-rurn
<br />or 7-day a~. ~_rugc a~ apprep~ic!e) permi. re.quin:matt for each pr_namcter. If none, enter "G".
<br />6. _.,.- "!-'ra;~ue~p'J~:,rJlj.cis" boGt as "SJn,,-l: !. i.-rv~rare,P" (actuat f'<;yucncy of scrap ing and analysis rased during
<br />,. .
<br />nomini~np, per~ud) anc as 1.„,ritR~?uu,•nur!"specified m pcunu. (u.g. L-nter ".•.a,"torconunucus muortnrr.g, "//7"
<br />iur unc dzy per v,~ce'.c, "1/30" Cor one day per mouth, "I!90" for uue day per quarter, etc.)
<br />S. Ea~a; "SJn~t L Ty!1' boor a. "SJC,lIe i•~'__!eu.am~o,t"(actual sample type rased durinb u;onitorin~ period) and v'T~•,~n%!
<br />k_ rirs.trs,%!,° (a.o~ 1',i:cr`"GrJr" fur individual sample, "34!!x' for 24-hour compasitq 'S`;~ir" for continuous
<br />monitoring, etc.)
<br />10. \'v°terc violation; of permit rcquirmcnts arc exported, attcit a brief explanation io ucscribe cause and corrcciivc actions
<br />to be token, and reference each violation by dale.
<br />11. 'f"no discharge" Decals dining monitoring period, corer "No Disebargu" across form in place of data entry.
<br />l2. ;'nl_•- "Na,r~/Tir/s ,j Frur~iFa! !-:r__u(ir_ G~ ~" wiib "Si;,~rr_r/vrs of Frirr.gv! E-r.:artivz ~:fjecer oj` Aurlvsriu:/
<br />A~;~nt. ""Tel~k;r;ne NumFer,"and "GaL" at bottom of form.
<br />13. Vail signed Report to Office(s) by date(s) specified i^ permit. Retain copy for your records.
<br />'.'ore detailed instructions for use of this Gisclurg~ tilonitorirrg Rror7 (Gb4F~ form may be obtained from OILcc(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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