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Paperwork 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 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. Envvonmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC X460; 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 imfotmation aUeady
<br />preprinted
<br />2. Enter "Permi((ee Namz/~Yloiling Adlrass (and facility name location, if different)," "Perini! Number," and "Dis.:horga
<br />Number' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Perin l"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "S~ntple Measuramein"data for each parameter under "~u~nrity" and Qualiry~" as specified in permit. 'Avtraz, " is
<br />normally rrit`tmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter
<br />obtzincd during "ivo,rrr%ring F~ri.J'; ",141Cinlluu" and i~4ininnun" arc normally eetreme hi~f, and low measurements
<br />obtainer; durng "ivfa%itoring Pzri-J". (Note to municipals with sccond.tq• treatment requirement: fintur 30~ay average
<br />of snmpte tncesurements under "Avo•~,;.,"and enter maximum 7-day ave+ngc of sample rnuasurements ohtained during
<br />monitoring period under "ivfaximunt.")
<br />G. F,n.c-°F,~,~,nitRravir~me.r["foreschparamcterumd:r"emu:ntih"and"~,,r~/i>)~"as~pcciGcdinp~rmii.
<br />7. Under "il,, Fr" e, der number of=am.ple measurement during mnr.(nrim,; n,rio~ a al c.xzcd masin um (nncLor ntinimnm
<br />cr 7-d.~y averge ss appropriate) nernit reyuirerncnt fitt each paruma[cr. If none, enter "b"
<br />P. 'n!er "Fr_•.fr~rr ;, ,~',;~,31;'s(r" tcGt rs "S..:,;;i [. ;,; •Jnr -,,, •ru" (achial frequrne}' ~~' a~nfiing r~r! a~alv,is used during
<br />moniiori tg perod) rnd as 'T",,,i, R~.uri,rm^n".pcciticd .n pcnnit. [;;.g. Ectcr "':,rr[,"for con icuor~s monitoring, "'r"'
<br />fir avc day per tvuc!c, "1/30"fur n tc day per month, "!/90" for unc day per quflrter, ctr.)
<br />9. ~•.ntrr "Slr,[,'t T;y e"bush a 'SS~„y 1, ;,;rr;urrr._at" (ucl,~al sample t}ye mcd r!uriug m.rnilorin~ I,criodi any. a; "r.: u,i;
<br />h~.}uir.•ara.~" (c.g. Lllcr "Crat" fur individual samp'r, "?d[[',' for 24-!-~nr:r unrtpositc, ".\'/,t" fcr cent,~cn~~s
<br />monitoring, etc.)
<br />10. B:^tert ~. iulatiu a of ncrrait requiremcots arc reported, attach a hricf explcna+io': to de:crihe cause aatd cunrc:'vc a 9nns
<br />to be fatten, and refurcnce each violation by date.
<br />1 i. If"no disch~rgc" occurs during monitoring period; enter "Nu Giacharge" across fomt in place nfdala entry.
<br />12. Enicr 'SVa,n. /Title rf Princil-~! E~~..-tr[ir~ %~.,r" uith "Sianlno~ ~f flip •iL1t £u_vniv• Q_f'i:~r ~j .I nr; •.ri'J/
<br />Agent, ""Tefephon ~ IJun,1 rr, "and "Cats " at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Cis,:barge 4f.ni[orine R.•Tsrt (L`b~2) form may be obtainud irum O.„s(s)
<br />specified in pemrit.
<br />Legal Notice
<br />'Phis report is requued by law (33 U.S.C. 13 ] 8; 40 C.F.R. 125.27). Failttre to report or failure [o report truthfully can result in
<br />civil penalties not to exceed $]0,000 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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