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I~~~aerwork Re~~action Act Notice
<br />Public reporting burden for this col]ection 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 pcr 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 aUeady
<br />preprinted
<br />2. Enter "Pennittez N~mz/Moi/trig Address (and facility name location, if different)," " Pa-mit Number," and "Discharge
<br />Nurnl•rr" where indicated. (A separate form is requited for each discharge.)
<br />3. Enter dates beginning and editing "i/.a:itorinb PzrioJ" covered by forth where indicated.
<br />4. Enter Baca °Paranrztar" as specified in monitoring requirements of permit.
<br />5. tinier "Ssmriz iasus!!r_ru.;rrt"data for each parameter under "Y uantiry"and ~~!a/i~ "as specified in permit. Averase" is
<br />normally arithmetic outrage (geometric a~cragc fur bacterial paramelars) of all sample meastrremenls for each parameter
<br />obtained during 'SL7:uin,rine Fario.j"; ",Y11.rirnuur" and rLFrnina~nr" ar normally eurcme high and low measuremenu
<br />obtained dying ".'.l,;ri!•.ri~rh f;rio~". (hrolc lu municipal; with secondary trealmenf reyuiremenl: Enicr 30-day avrragc
<br />of a^nplc mcasrscm::nL; under 'i1v.:r16_,"and enter maximJn 7-day average of sz:nplc measurements obtained during
<br />manimrirrg period under ",Ll~cinwn.")
<br />fi. Er.cr''Pe,;tri!I~/uiranznt"Car each parameter un.d~r "~:unti ~~"and "~uolity"as specified in )a,~ui[.
<br />7. lindcr "Pro Er" en[s mm~uer of sample inetsare:rent during ~noniton rig h,ried U~zr exceed max~mum (acdlor rninimurn
<br />or i-day aVCragC 8S appropriatt) parmii mquir~nnca for eacb parameter. If none, cater "0".
<br />S. En'c. "F'ed;~rre,~.~, %f fi,r~7;aA" L-uth zs "S'.m, /s :. ~~.ruu~e,a •u!" (a;:fual frcyucncy oC s~ ~~laing and analysis used during
<br />mon~lorin.g pcr.od) and as "/'_~.~ait R~_i!•ir_n!~m"~pccified in pcrrnit. (c.g. Enter ",out,"tu! continuous ~onitotiug, '7/7"
<br />for one day pcr wca ~ '7i30" far one day per month, "1/90" fur one day pcr quaver, etc.)
<br />S. iiu'.,r "Sang l~ T~F_"both as 'S'r,r/. LL:.: wr~m_r~t" (actual sample type used during monitoring period) aril as ". _~ru;t
<br />R:./virs;ar,t," (e.g. Enter "Grate" Cor individual sample, '2-1H~" for 24-i~our computiita, "rL%A" for contnuous
<br />monitoring, etc.)
<br />] 0. }'/ltere violations of pavdt requirements are reported, attach a brief expla!ration to describe cause and correclivc ac:iuns
<br />to be taken, and reference each violation by date.
<br />1 I . Tf "no discharge" occurs during monitoring period, etitcr "No Discharge" across form in place of data entry.
<br />12. Enlc "Tl~m/Tirr_ ~J f rincir~[ Ex~, utiva Cf~a-" with "Sism.rlur,: cJ Fria, it~~l £.r~•^uln~~ C~~er of Aut;n.-i_-"/
<br />Ager!t, ""TakFhcaz Nwnher,"and 'Tarr" a[ bottom of form.
<br />13. Mail signed Report to Office(s) by note(s) specified i^ permit. Retain copy for your records-
<br />14. More detailed instruc[ioos for use of this Ph•.karge 1Nmitorirrg Rrpa7 (Gds form may be obtained from O1Tice(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. ] 25.2'n. Failttre 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 no[ 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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