~`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)
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