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Paperwork Redaction 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 bouts 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 />1. If form bas been partially completed by preprinting, disregazd instruction dvected at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/Mailing Address (and facility name/location, if different)," " Pernrit Number," and "Discharge
<br />NumEzr" where indicated. (A separate form is required for each dischazge.)
<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 "Semple rLfwsurerraal"data for eacb parameter under "Qu1:rlity"and Quality" as specified in permit. ':4veruga" is
<br />normally arithmetic avenge (gcomeoic avenge for bac'crial parameters) of all sanp!e measurements fcr etch parameter
<br />obtained during "rtif~niroring Period'; "iih~,:inrurn" and rL1i.t%;;;uor" are normally extreme high and low measurements
<br />obtained during "i I.ni[.ring PerioJ". (1`lotc to municiprls ~:~ith secondary treatment rccvrcmcnt: Enter 30-day avenge
<br />of simple m=asurcmcnts under "Avzr~g:,"and cntar maximum 7-day av~-agc of scmple measur,;mcnts obtained dur:r;;
<br />monitoring period under "Mcrximurr. ")
<br />6. Enter "Penrrir Re~rti; _+nen!"far each parameter cnd_r "_'r~rrir,~" a •d "Quality,," as specified in p_rrrit.
<br />7. Urder "T.r~ F,.-." enter number a` sarn~l„ m_rscre-.~,; i' c;~~~n~ monitor c~ ,-c~~od thn; e~ crrd rn;_;:in ~m (anJor mia:.. n
<br />or 7-day avenge as appropriate) pemit reyuirerner t ;ur cacti prrmetcr. ]f none, enter "0 ".
<br />S. ~nier "F,-.~uen_y of A;ralysis" both as "S:,.gle i,/c' •r•r_,a~.r~" (rcitul frequency of sempli~g ord an<'ysi: used du :a;;
<br />moni[o~ing period) and as "P_;nrit R,:;a4.,,.s„?"specified in permit. (e.g. Enicr "~zn!,"for COnI'IRWLS i00n110rng, "1/7"
<br />for one day per wee::, "1/i0" fo- one day nc- mnntS, "1!90" for one day per quarter, etc.)
<br />9. '=nl::r "S~mple Type" both as "S ~nr,~/.r ,',laac~~; :.pert" (actual sample type r sed dur'r;, monitoring period) and as "".~r„ ~i!
<br />T~7eriremr,d," (e.g. Ent~° "Groh" for i~rdividucl sample, "14NC" for 24-bent composite, '^!/A" for ca ' ~ uoa
<br />monitoring, etc.)
<br />10. `Crlrere violations of permit :'equ `-cmer!s arc -rporxd, rttecb a brief c.:p:aaation [o c:escribe cause rod coTCCt~vc uai~~r
<br />to be taken, and reference each violation by date.
<br />11, If "no discbargc" occurs during monite iro period, e ~' _r "i:e t;'sci~: roc" across fo-m in arose of date envy.
<br />12. °nter "Nanr~/Title of l'rirt.:ipal r_r.~_errira !:~~_•r" w`th "Si~ma!._,s of Prin_i~~t ._.,,~ativa Gffr~s,• -,,".:.•'t,.::,_
<br />Agent, ""Telephony NmnFar,"and 'G,~fe"at bottom of fo.,n.
<br />13. Mail signed Report to Office(s) by date(s) speci5c'_ iu pe~ruit. P.etain copy for yaw records.
<br />14. More detailed instructions for us:. of this Gis~ha;6s :~f.,ritrirro R_•,~~ri (GA9R) fo~~n may ba obt:in_u fr, r ~, ;
<br />specified in permit.
<br />e
<br />;:~ ~C,., ~vu..:u.d.
<br />This report is required by law (33 U.S.C. 131 g; 40 C.F.R. 125.27). Failure to report or fai]urc to report truthfully can result ~~
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violas io ~,
<br />or by imprisonment for not more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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