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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, seazching 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, disregard instmction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permitlee NamelMailing Address (and facility name location, if different)," "Permit Number," and "Cischarge
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Pericd"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of pemvt.
<br />5. Enter "Samplu M_asursrnznt"data for each parameter under "~antity"and [kralit}~" as specified in permit. "Averaga" is
<br />normally arithmetic ave age (geometric average for bacterial parameters) of all sample measurements for each parameter
<br />obtained during "Monitoring Pzricd'; ".YL~xinunn" and rLlinirnrrm" arc normally extreme 'sign and low measurer•tcnts
<br />obtained during "df~,nitorirrg PerioJ". (Note m municipals with secondaq• treatment requirement: Enter 30-day averay:
<br />of sample measurements under "O.vzr~ga,"and enter maximum 7-day average of srrple maaslrements obtained drrn,g
<br />monitoring period under "Maxinrurr.")
<br />u. l;nter "Per-mil Ra:]ui, _r;;d:rt"for sacs parameter under "~uantiry" zrd "Quality" as spccured n permt
<br />7. Under "No /:a" entcv number of sample m_: surcmen! during monitorn„ ;;_rnd ihet cscccc' maxim,~n (cni: o- rrini -r,;.'-
<br />or 7-day avenge as apprcp~iate) permit rcqu~:ameot far each parameter. If none, eaL^r "0".
<br />8. ='nter "F,~~auarr~y ~.,`Arr:lysis" both rs "5.,,,,,~L ;~L•~~ar~,o:r„' (actual frequency of sampling and an~lysi; tssed dr'tin~
<br />monitoring pccicd) and as "Par,ait 2?uir~ru_;rt"specified in permit. (c.g. Enter "^.,ar,"for continuous monitoring, "//7"
<br />for one dzy par wcc'.c, "1/30" Cor one day per month, "7/90" fcr one day per quarter, etc.)
<br />9. Enter "Sample T Pe"both as 'SJn±FIz Lf~JSru~e;ndrr" (zctual sample type used durn„ monitoring period) and as "P,tn.rit
<br />R:~:rireme.a," (c.g. Enter "3raF" for individual sample, "14H~" for 24-hew- carrpositc, ",17A" for continuous
<br />monitoring, etc.)
<br />' 0. Plbere violarions of permit requirements ar rcpcrtcd, aYwch a brief explanation tc describe cause and eorrectrve actions
<br />to be taken, and reference each violation by date.
<br />11. if "no discharge" occurs during maniterin~ period, entcr'T'o D+scharge" across fern in pace of data entry.
<br />12. Enter "Name/Tir!a of °,vrcipol P:~_cutice G~_•u" with "Si,;nahn~z rf A-in. ;-mil F.raculiv, (,~~"• cf leC,'ro,-it~J
<br />Agent, ""Telephone Nwnbzr,"and "!_'atz"at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for you- records.
<br />t4. More detailed instructions for use of :his Cis:ha.~z rL; i,rit.riug R ;~;, t (C,L,'l~ `arm msy be obtained from Cf°= '~
<br />specified in permit. Tf ~I T~
<br />iL.~~`c~.ll I~c'~Lc~W
<br />This report is required by law (33 U.S.C. 1318; 40 C.T.R. 125.27). Failure to report or failure to report truthfully can restdt 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 mot more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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