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I~~~~:~~;rwork 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 ] 10 hours as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 181~otus 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 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. Eoter "Pern7iuee Noma/Nf~rling Address (and facility name location, if difTeremt)," " Parmi! Number;' and "Discharge
<br />Nunlbar" where indicated. (A separate form is required for each dischazge.)
<br />3. Suter dates beginning and editing "A-Icnrtonng PanoJ"covered by form where indicated.
<br />4. Enter each "Param~l~r" as specified in monitoring requirements of permit.
<br />5. Enter "S~l,rpL ,S4_asvrdm_!rt"deter fen each parameter under "quantity"and dull%!r" as specified in permit. 'Avrr~ge" is
<br />^ormatly aridtmetic r ~'eraoe (gcomc,ric average for bacterial parameters) cf all sample measuremcos for each pa~amM~r
<br />nb:a+ned durS-~g ",Lkr+i!>r6re Iarisy"; ",tLr:inrrw!" a,td rvlininum7" are normally ~etr.me high and low measuramcnts
<br />obtained dwun„ 'S: r, r%r ; irr5 Pa-i~. ~". (ldote ro municipals Hith secondary [natmcn? rcyuiremcrt: Enter 3~-day a~e-aga
<br />of s..nr,t;, m.~surcmcnts cv ~r,:r "f. va: ~ ~_ "and enter m; ximum 7-clay aecragc of sample mcas urzmznts obtained dwing
<br />monitoring period under 'Si•Jasimun7.")
<br />u. .°.~r.~r "p:•, unit Fu.ivL~ -,,, •. ~r" "or cectt parzmc:~r ta,d:r ' ~r•,nrin." cr,u "~.rr~/ir.; "as specified i u pcrmi;.
<br />7. U'd~ ~ "i'•. F:" r-~~_ uumbcr of son t'c m~ aunmcni during ma~~~li~~ing p„ god :I':rt c~z_ac, rna.~n~~um (.md/cr miut.rum
<br />er ~-dcy aver „o r-, a~prnprin~e) ncnnil reyu~rcment far each parnmeter. If none, enter "0".
<br />8. '-r:z~. "I ~ .•~,,.n.: ,,f,:r. ~!~•cis" both :~ "S_•::;r /.~ n6 r:rn •,,, •nr" (acnirl Frequency a';;:mpling s,1 analysis aced durng
<br />:auri~ur^.o nn;od) end .+ "T_n•rir R:.urir:rn.•r,r" •pccilled in permit. (c.g. finis '•..~.•~!."for cunlinueus monitoring, "1 r7 •'
<br />f ~r rnre day u~_r v:a:c, "1/j0" fur one day per month, "//90"for one day per quarte•~, etc.)
<br />-'
<br />S. ~i per ".S~rn,~l • T~•- ° both as "S,uar/.• '.,'_•ac~rr-n -M" (act ,al sample type used during monitoring period) and as "r _:w;%
<br />R~awir.•m~r.t" (e.g. C'nLe. "Gnat" for individv;~l sample, '7~IH~" for '_4-ho::r composite, •'Al/A" for continuous
<br />monitoring, etc.)
<br />10. Cl;turu eiulrtir:zs of pcrrai[ ruquirernr.nts are reported, attach a brief expl:,»aiiun tc deticribe cause and corrcct:vc a::imis
<br />'.o be tal:cn, and reference each violation by date.
<br />t' . ?. "no d;sctt~: ;e" occurs during monitoring period, cuter "No Disuhargc" across form in place of data enhp.
<br />12. timer ".\r ~r,7=/Ti11~ of Priu, iF~! F.*=_urirs ~.~.~rr" with "Sib~r~lura rj Frin_i~;,! [xz_rarty: Gu~i_ar~ rj A~r;vr i=aJ
<br />Fg~nl, ""Talapi7on ~ ,lhunhe, ; "and "Date " a[ bottom of form.
<br />13. Adail siomed Reou~t to Office(s) by datz(s) specified in permit. Retain copy for your records.
<br />l4. Mo7e detailed instructions for use of this Gischarge rLf~niloring Ran .rr (I'rLIR) farm may be obtained from Ofiuc(s)
<br />specified in pemtit.
<br />Legal Notice
<br />Tlils 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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