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T~~:~erwork Re~nc~:aon Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours zs 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 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 />C°neral Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. En[cr "Parnrirtae Name/Mailing Address (and facility nameAocation, if di[Terent)," " Parmif Numher," and "Gischarya
<br />Nurnher" where indicated. (A sepazate form is required for each discharge.)
<br />3. Enter dates beginning and editing "idoniroring Pdriof"covered by form where indicated.
<br />4. Enter each "Faram~ter" as specified in monitoring requirements of permit.
<br />5. enter "SJrnF!_ ALasuramnt"data for eadt parameter undzr "quantity"and ~~uality" as specified in pcrnit. 'Av~r,vb~"is
<br />normally aridvnetic average (geometric average fur bacicrial parameters) of all sa,-nplu measuremunls for each parameter
<br />obtained dining ",L%~,ni1•.ri,rg Fa-ioJ'; "a9Jxirrma" and rLlininurm" are nurnally e~Ireme high ar~d low mcasurrntcnts
<br />cbtt,iocd dm ing ".LP,nir.ri,rg F_•rts„1". Q~'ote to municipals with secondary trectmer.t requirement: Enter 30-day average
<br />of s°mplc measuruments under ".±r~wos," aid enter maximum 7-day average of s~nnle mtsstncments obtained during
<br />motzitoting period trader "ivlaximun..")
<br />E. Er:c.- "F.rmir R~; uirtrnsul" nor each parameter mrdcr "~{tr_rntir~," a:r,d "~~uality" ac specified in p:rn~'.
<br />7. :;••der "/r; r" en: nu,nber u"sample ma-.r~.re,: _nt dung muniioring period Lliat cvicecd rnax~mum (and/or min~mun'
<br />ut i-dcy average •rs as ropriatc) nnmit requirement for each parameter. If nano, enter "0".
<br />3. _. _- "/-'r:;rr ~~ ~~ ~; :~,u!jrc" 6o'h as "SJ.,,; G .h!venr-.rn.r:"(acC~.al fmqu_ncy urs.anpliug and analysis usc~ dwutg
<br />nor.'tnrng perio~; and as "P •; ,:rir R.rrrir~nun~"spccifie.d in pe-mit. (c g. rn~ur '~~.n!,"fur continuous moniw~ln~, "//7"
<br />for ur:c ci:y p; r v:•ee':, "1/30" for one day per month, "1/90" fur one day per quarter, etc.)
<br />,. ':m _r "Sri!:!, T~Fs'• oath as "°_~,;;F/a 6:rs_5arr_m_nt" (actual sample typ,: used durng moni~.oring period) and as "Fermi!
<br />k_.luirtar.at," (c.g. G^Wr "Graf-" fur individual sample, "19H.:" for 24-bout composite, ';1--%L" for continuous
<br />monitoring, etc.)
<br />'G. C,Sun, rielaia~~s of,,:rrri~ reeuircments are reported, attach a brizf explanation to describe cause and corrcetive ac+iu~s
<br />to be taken, and reference each violation by date.
<br />11. I~ "no discharge" occua during monitoring period, entry "No Discharge" across form in place of data entry.
<br />]2. =n:er "iJJUrs/Tills uj FrinciTJ( F_rz_~nire G~~~r" with Signahue of Frin_iFll Ex~_7div~ Geer of ~;nr,'r~rizel
<br />riFsnl, ""T~!_•Fh arts ASrmh~ r, "and "Date " at bottom of form.
<br />] 1. tt.ia it signed Report to Office(s) by date(s) specified i^ penttit. Retain copy for your records.
<br />;. ivrure detailed instructions for use of this Dis;;harge Aonitoring RaF-,r! (Gd~iJ form may be obtained fmm Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is requimd 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 man; than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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