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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 bows as an
<br />average per response for some minor facilities, to 110 bows as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 18 bows per response, including time for
<br />reviewing instructions, searching existing data sowces, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of information, including suggestion for reducing this bwden, 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 Iafoanation and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form bas been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/Mailing Address (and facility name location, if different)," "Permit Number," and "Dis.:hargz
<br />Number" where indicated. (A separate form is required for each discbazge.)
<br />3. Enter dates beginning and editing "MoniNring P'zrir I" covered by form where indicated.
<br />4. Enter each "Parrnnetzr" as specified in monitoring requirements of permit.
<br />5. Enter "S:mrple ,trkasuremzn!"data for each parameter undo "^.rrontiq•"and ~iualitp" as specified in permit. "Avgrag,:" is
<br />nomiaRy arithmetic average (geometric average far bacterial parameters) of all sample measurements for each parameter
<br />obtained during 'SLlsnir;rine ('aria'; ",141rinu:,n" and blinimruu" are normally extreme high and low mcasu-cnncnts
<br />ohtnined dw-ing "df-,ailo;inb !-a-ia". (Vote to municipals with scccndary treatment requircmer,L' Enter 30-day avcragc
<br />of sample measurements under "/.vaa,;.;,"and enter me.ximum 7-day avcragc of sample mcasurcnents obtained durint;
<br />monitoring period under "tLJarinrunr.")
<br />6. 'in:cr"F~~;;ni!!L•Irrir~,rte;rt";orcachparamcterund,r"~u~+,:i/;~"an'_"~u~li(r"asspecifi~dinparrr.it.
<br />7. Uader "A'.: E':" color number of sample measun;ment d:u-ing rnonihrine n~rind'h ~t :.:cced c a~.lm :m (and~or mini~nuu,
<br />e-7-day ace~~gc rs zppropriate) ncnnit requirement fur each parameter. If none, enter "0".
<br />.,. En •~r "F)-a;r;t~;t_7~ %j~tr+al~trrc" both, ac "Sa;:;rL• /v,'•s„r, ,;~_n;" (adikl ^cqurnr; of ~amnling 2nd analysis usai d.ring
<br />monitoring pcr,od) ands "!':r„+i. R~yuirru;.•;d"sneciGcd in ; cnnit. (~ g. Er~!,r "~,,.r,"fcrco~~'inaau: monilorir„ "/./?"
<br />fer one day per r: ed.:, "1/30" for one day per mn stn, "!i90" far ore day p,cr quarter, c'c )
<br />7. Icnler "S.m11_ 7; F."bolir 2v "Bird/{z i f~,~sura:;_n!"(e:h:al sr,mplc 1, p. us::d Burin;; moni[orin;; nerind) end as "r,•rmi!
<br />R.:adirzrn~nr," (e.g. 'inter "era!'" for indit~icual sanmL, "?dl;_" fer 2d-`o:.r composite, "is'/A" for con~in:;ous
<br />monitoring, etc.)
<br />] 0. `.`.'h„~a violations of permit ree,uiremcn'; arc -cawed, attach a brief axpl2nation. to dascribe causu and cortcctivc actions
<br />to be taken, and reference each violation by date.
<br />1 ]. If "no discharge" occurs during monitoring period, enter "Vo Discharge" across form in p)xe ofdata entry.
<br />12. Enter slam.ll'iJlz of f'rincira! L•sa~uth_• %1f__r" with "Si~n,vurr cf ~';~%.a~i/ r.' F..r_.vriv_ jfi:z,• of Arrth'.rizeJ
<br />Ananl, ""Ta{zplr r.: Numbar,"and "/eau"at bottom of form.
<br />13. Mail sided Report to Office(s) by date(s) specified inpermit- Retain copy for yow records.
<br />14. More detailed instructions for use of this Gis=barge hLnitoring R_Icrt (C1v1R) farm may be obtained from O~cc(s)
<br />specified in permit.
<br />Legal Notice
<br />This 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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