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~`aperwork Rerl~~tio~ 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 sottrces, gathering a.nd 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 />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 "Prrmittee Name/Mailing Address (and facility name/Iccation, if different)," "Permit Numher," and "Discharge <br />N:emEer" where indicated. (A separate form is required for each discharge.) <br />3. Enter dates beginning and editing "Monitoring Pari~d"covered by form where indicated. <br />4. Enter each "PJramaldr" as specified io monitoring requirements of permit <br />5. Ente* "S~rnpk ,tl~zrur~~m; nt" d: ta for each parameter under "~rnnlily"and Qnalih~" as specified in permit 'Avarag-" is <br />normally arithmetic :.verage (geometric average far bacterial parameters) of all sample mcasurenen_s for each pa*arnef_r <br />obisincd during "af.ei!;ri,rg Fdri~ia'; ".•/:,a:iluum" and i+4inim:an" arc normally cxt~crnc high and ton measu~e:rcnts <br />..^,btained during "•Lf~~ri!,.in~ Peri;d". (T'o[e to municipals c,ith secondary treatment regwr~menL• Entr-,r 30-day avr+r~c <br />ofsamp~c m.astvcmentti u:,dcr "Av,•r~~a,"and enter raaxi~~,ur-~ 7-day average rf,a;npie measurements obtained d:.-irg <br />monitoring period under "~Ylaxinrmn.") <br />6. °.n~cr "F •,nir R~./t,u anz,rf" "or each parameter undo "tlr ~nli(r" a^d "~+vliN" as specified ~n perrnii. <br />7. U-d.r'Y:'-, I's" enle: number aP sample ma~s+ rcmrn; during m.n~:ito;ing ~,,~~nc' t'~,,a e~. recr; ma~: a+~_m (:md/or mirumwn <br />er 7-dry averzgc •as a :pro;+ricte) permit rcyuircment fln each parameter. !f none, enfi[ "fi". <br />,,. : n.es "F; ~_p,.;r_; ~y`,fr:.l;•~ ;" bclh as "5:,..,-1~ S•k~rr, r.,,d, !" (acfua: "rcqucccy o~" sampling aid tuialysis used dvcn~ <br />~nani[uri,g pe~'nd) and as "('e,,.+i~ R~_;r~i,•nrcn!"specified in peon''. (c.g. P~~;cr "..>,nr,"ibrcontinuous manitcrino, "i/7" <br />f ~r one dr,y per r; ,:etc, "1/30" far our, day per mnnUt, "i/9U" nor one dny ; er quarter, ~'c.) <br />4. Entcr'(S.'m, !. T};~-"both s ':°~;,tF(z .~za.+!ve,;; -,i!"(r:_f~~al sample type nscd c:uri~:g monitoring period) and as "r-,ni%- <br />Rt./uir_nunr," (e.~. r.ntc- "Graf" for individual sampic, '741/: for 24~~our composite, ';~%k" for con•inucus <br />monitoring, etc.) <br />10. ~'Jiiarc viul<-tiu~s of permit requirements arc repented, attach a hriuf cxptanr.tion to describe taus- aid corrective ac yens <br />to be taken, and reference each violation by date. <br />l 1. if "no discha+o~c' o::curs during monitoring perod; entrr "~lo Ducharoe" across form in placr of da4•~ envy. <br />I%'. tin:cr "N~n=/Tid,; of Prirrcif~! F..r~,•tlrirr L~:s" with "SiynJhr,'a of /l iu_i/ 1! Fsdarrin~ Ci/ji:rr uj Avllr.,'i=_• 1 <br />figarl, ""Te/aplroua ,Nunn[ er, "and "Gala" at bottom of form. <br />13. ,btail signed Rcpcn to Oflicc(s) by date(s) specified in permit Retain copy foryour reconls. <br />14. Moro detailed instructions fOr USC of th1S Lls./J9rgz ,L/.nllO!'lY7h' 21. ,r! (L,11R) form may be obtained from Oi ice(,) <br />specified in permit. <br />Legal Notice <br />T1ris report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure [o 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 imprisonmemt for not more tham one yeaz, or both. <br />EPA Form 3320-1 (Rev. 03/99) <br />