|
Paperwork Deduction 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. 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 />I. If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permi((ee Na,ne/Moiiing Address (and facility name location, if different);' "Permit Number," and "Discharge
<br />Numbsr" where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Perio.~"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "SanFle Nleasm-mtent"data for each parameter under "Quantity" and Quality" as specified in permit. 'Average" is
<br />normally arithmetic average (geometric average for bacterial parameters) ofa(I sample measurements far each parameter
<br />obtained during "Monitoring Pa~-iod'; ";A:uimun, "and ,Y;irinnrm" are normally extreme high and low measurements
<br />obtained curing "bionit~ring PerioJ". (~!o:e to m~icipals rviCb sccvndaq~ treatment requir_ment: Enter 30-day avemgc
<br />of sample measurements undo: '~r:rJge, " z,rd enter mcxiurum 7-r;ay average of sample measurements obtained dur erg
<br />monitoring period under "i/,azimurt.")
<br />6. Enter "~ernrit R:/tti,•:men!" For eacb pzr m~tcr tmdrr "Qer_~ntitp"and "Quality" as specified in permit.
<br />7. L'nd:r "Nrl F_.%' enter r,:u~bcr ofsa~a,i_ ~-casu:-.:-n,.a c~ing,nocitor:ng pcried Coat exceed maximum (and/or mini:,-..ni
<br />or 7-day average as appropriate) pami: rcqu:remcr.~ fur each parameter. If none, enter "0".
<br />8. Enter "Fr. fu:r.~ry oj~:.vlycrs" 67h as "S_~,,, !: , •:r_~se ~~,;.ra/" (actual frequency of sampling a:nd analysis used dLrri,g
<br />r:onRcringperiod) and as "Fa%,utTi.e;,ui,r.,tsni"spu~ifiad in pormil. (c.g. Enter "^snl,"for continuous monitoring, "1/7"
<br />for one day per eree§, "i/30"fur one r:ay per moaur, "!/90" far ovc day per quarter, etc.)
<br />S. F.nte; "Sa,:rple T,•~F~"bath as 'SaraFls .. `s:uerent~r.t" (aqua: s':~nptc type used dw-~ng mvni:oringperiod) and 2s "Pennii
<br />R~,jui,~an~n[," (e.g. En[cr "Gra!'" for individua' saJnplc, "14H~" for 24-hour composite, "N/A" for continuous
<br />monitoring, etc.)
<br />10. \irrere vin:atiors of permit requir„ncnls ur. rtporte•', CtacL a bzief e::planation to describe cause and corrective actions
<br />to be ta'sen, and reference each violation by date.
<br />11. IC"rev discharge" occur during monitorng pc*ivd, em:ur "~'v Dis=barge" across ferm in place ofdar~ enGy.
<br />12. Enter "Nar,,z/'1'i;L r.~` F-ineiFa! E.:acutive !ijjr__r" with "5'ibrlt~~re of Prin_iT~l 6ze:.vlive Officzr of Arthor-uJ
<br />Agent, ""Te/eFhenaNurtbe~ "and "tale"at bottom of form.
<br />13. ;vial! signed Report to Curce(s) by date(s) specified irr p::wtit. Retain copy for your records.
<br />1=i. `!ors dc:ai:ed instructions for use of this Discharge i.i;.,itcrino T~To;4 (I7;~ form mug b~ obtained from Of-flee(s)
<br />speci r led in permit.
<br />~~~~.li T~©~,'~"~~~
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R 125.27). Failure to report or failure tv 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 no[ more than one year, or both.
<br />GPA Forw 3320-1 (Rev. 03/99)
<br />
|