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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, disregazd instruction d'vec[ed at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/Moiling Address (and facility name/location, if different)," "Perini[ Number," and "Discharge
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each 'Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Srn,rple Mzasuramen[" data for each parameter under ",2rrantity"and Qualit)~" as specified in permit "Average" is
<br />normally arithmetic average (geometric average for bacterial parameter) of all sample measurements for each parameter
<br />obtained during "rYoui[oring Period'; "i:d,crinrwn" and rYiinirmmr" are normally ext-eme high and law measurements
<br />obtained during "i+.:;:ri[oriag P_riocf". ('Vote to municipals w. ith.secondury treatment requirement: Enter 30-day average
<br />of sample mcasurcments under 'Average," and enter maximum 7-day average of sample measurements obtained during
<br />monitoring period under "Ivfazimum. ")
<br />6. L-nler 'Pe;;,:ii R;.7ui, ement" for er_h parameter under "Qrr_mliry"and "duality" as specified in permit.
<br />7. Under "; ;'u F:•" enter ;rumba of sanp'c mcasuremari d~.~ing monitor.'ng period lira: caceed maximum (a if/o~ mir; ..m
<br />or 7-u'ry a~~eragc as appropriate) permit reeuircment for each pammetcr. L'' none, e rter "0".
<br />8. ;_nter "F,=lr~ •,._y y'A:ralysis" b~Jr ..^s "S~rrFia iA_•_ se~ane::+" (actual fraluency cf samp'~ng and ~~aiysi; used duriac
<br />:nonito,ing pc:iod) and as "Fer;nir fm~~tire,aenr" specified in pcnni.. (c.g. L-nter "Con!," fu,-continuous moei~oring, "1/7"
<br />for or.^ day pct vrc:.k, "l/j0"for cne day per month, "1/90" For one day per quarter, etc.)
<br />9. °nter "S~,r~./~ TjT."both zs "Ssmp/s A-;:as:o•em_mr" (aciual srJnple type acni d~r~ng monitoring pe~iad) and as ""~nnit
<br />R,:;lzrireme,rt," (e.g. Enter "3rab" for individual sample, "19H^" fa: 24-hour cumpcsi[e, "N/A" for continuous
<br />monitoring, etc.)
<br />10. \;~.re:e vi::'aliuns of permit requu~emeuis are rcpored, coach a brief explasalion tc dascri~z cause and corr~xaive act;ons
<br />to be taken, and reference each violation by date.
<br />1 1. 'f "cu disc:~arge" occurs during monitoring period, enter "D!o Disch~-ge" across form iu p'acc ofda+a entry.
<br />12. Enter "Narrr/TirL cf FrinciFa! Exe_utiv~ G/jcsr" with "Sigorahrrv rf Prin••i; 1! T*e_u[iv~ Gffi_'er Gf Aul;rsrce~
<br />Agrnr,""T„leplrcr_Numhzr,"and Ga[a"at bottom of form.
<br />13. ~~~a::.:igncd :Zcport [u Cllicc(s) by date(s) specified in permit. Rewin cupy for your recous.
<br />I ;. "'urz dewi'ed instruclioi~s for use of this Discharge i.9-~niro,ing ~Fo~? (DrLr7~ °c ~n ray ba obiained from Office(s)
<br />specified in permit.
<br />Le~afl N®tIlCe
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or fai]ure to report truthfully can result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exec:ed $25,000 per day of violation,
<br />or by imprisonment for not more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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