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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 mirror 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. Endtrottmental 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 directed at entry of that information already
<br />preprinted.
<br />2. Enter "Penzzittee Name/Mailing Address (and facility name location, if different)," "Permit Numher," and "Discharge
<br />Numher" 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 specifed in monitoring requirements of permit.
<br />5. L-nter "Sample Mzasurement"data for each parameter under "Quonlity"and ~aliq~" as speci£ed in permit. Average" is
<br />normally arithmetic average (geometric average for bacterial parameters) of al] sample measurements Tor each parameter
<br />obtained during ",Llonila•ing Period'; 'Shl~simum" and ,Ylinimum" are normally extreme high and low measurements
<br />obtained during ";vsait~rirrg Period". (Note to municipals with secor.dzr,- trc~tmer.t requirement: Enter 30-day average
<br />oP sample measurements under 'Ava•ug.z,"and enter maximum 7-day averngc of s,:mr~lc rreasurcmenls obtained during
<br />monitoring period under "iY.aximum.")
<br />6. Enter 'Peruii Relrrirament" for each parameter under "Qu~nlity"and "~aaliiy" as specifictl in pcmait.
<br />7. Crdc. "~\'u F.x" onto.-number of s~mp!c :rcasuremenr c,u:ng crouitorng period thct c::eeed ma:cimum (anchor mini-r..w~
<br />or 7-zL y aecragc as appropriate) permit requiremeut for each paramclci. [fnonc, cnicr "0"
<br />8. Enter "Fro:µr_r,_y cj ~:uo/ysis" b Y'r as "S1rz, !..~1-,~sr-: _vrrart" (actual frequcn ;~ of sampei ig rrid analysis used during
<br />monitoring p, riod) and zs "Fd;ro;rit 2.luirarnar["specified in permit. (e.g. Enter "~:n~,"for continuous monitoring, "//7"
<br />for one day per rce!c, "1/30" fur one day per monti~, "1/90" for one day per quarter, etc.)
<br />9. Euter "°ar;zpL• TAE.."bath zs "SaznE•k rb;:aszu'~m:nl" (actual s:.mple Type used dur_rg monitoring period) and as "Pzrnzit
<br />Rayuireme:rt," (a.g. Enter "Grab" for individual sample, "14H~" fo: 24-hour composite, "T!/A" 'cr continuous
<br />monitoring, etc.)
<br />10. \Vhere violations of permit reyuiremen[s arc rcportol, coach a crier explanation tc dc~cribe cause and co-restive actions
<br />to be taken, and reference each violation by daft.
<br />11. 1f "ro disrirarge" occers during monitoring period, enter "No Discharge" across form i n place oTdata entry.
<br />i2. Enter "Na,:re/Ti~le ',f Frin~ipat Exe~utivs O~(jicer-" c~idr "Sion!:rr~ of rr7n.~ta/ Fce„zaive G~•_•er cf Aerthoric,.°d
<br />Agent, ""T~leplrone NzrmPer, "and 'Gate" at bottom of form.
<br />13. n-;ai! signed RapoC to C,Tice(s) by date(s) specified in pcrrnit. Retain copy for your records.
<br />1'.. ?%orn dc:ailad instnctions for use of this Discharb~ ivionitsr7ng P. ;art (D;~If2) four may be obtained from O(Tcc(e)
<br />specified in permit.
<br />~~~~,~ ~~~-Il~~
<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 crimina] penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />
<br />lv?A Form 3320-1 (Rev. 03/99)
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