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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 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 />I. If form has been partially completed by preprinting, disregard instruction dtrected at entry of that information already
<br />Preprinted.
<br />2. Enter "Permittee Name/Mai/ing Address (and facility name/location, if different)," "Permit Numt;er," and "Gischorge
<br />Nunt6er" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Moniroritrg Period"covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sampla .bl~zsuretn~nt"data for each parameter under "~ltantity"and Qe.~lig " as specified in permit. "Avzraga" is
<br />normally a*ithmetic average (geometric avenge for bacterial parameters) of all sample measurements for each parameter
<br />obtained dur'n~ ".1'1-.t« torntg Prod'; "i11zx%uv;a" and Nliniurtun" arc normally extreme high and low measurements
<br />obtained durin,r, "P:Lnits. iub Psriod". (Note m municipals with secondary treatment r.quircmcnt: Enter 3f`-day accrs~^
<br />of ramplo macsurcmcnts under "Avan6~,"aad entc; maximor 7 day average n` s:.-iplc mcas.rments obtained d ring
<br />monitoring period under "Maxinmm.")
<br />6. Enter ","el$'lll ~t..'.]1!1!'!iiid;lt"for each parameter under "qua:«ir,~"and "Quality" as speci tied in p~rait.
<br />7. TJr~tc- ",'t'-, .'_'°" ert~- number of sample merswc-cn' during monitoring ; =rod tha' e•:cecc' ma;: rm.~m (rnd,'~r mini-,::n,
<br />or 7 ~~y avcmge as a_.propriate) permit requirement for each pat2mcter. If none, cnLr ".7".
<br />P,. °nter "F.-s/t",1.Y G~~: L_(y'c%.S" both as "S~.al/~ .11•lcu;~,;u:;1" (a.fia~ fr.:~u_ncy of s:,-~pGr.g end r~~~lysis used during
<br />monitorng period) and as' ~°~~,~.,i! Rz;iriram:.~t" specified in pcnnit. (0.0 [inter "Cc,l;,"far continum'; monitoring, "//7"
<br />for one day p.;r ~~eek, "!/j0" for one day per month, "1/90" far one day per quaRcr, elc.)
<br />S. Dater "Bann-!.• Ty~~"bo~ti as "S-rmpL I'4_~.cur.~r,>,•,-t" (actual sample type used du~irg n ,ni?o-inr, period) and as "f'?;wdt
<br />Raqui:•rnr~at," (c.~. Enter "Gra!-" for individual sample, "14//x" for 2'~-hour c^nposite, 'S`I/A" far continuous
<br />monitoring, etc.)
<br />10. \`~icrc violations of permit nequ~remer.ts arc reported, attach a brief explanation tc dercrib. taus.: and coscciwc ac'ions
<br />to be taken, end reference each violation by date.
<br />11. ?f "no discharge" occu-s dwing monitoring pe! god, entcr'T'o Discharl;c" across form in pl: ce of da'a cn~ry.
<br />12. L-ntcr "NJm,/TifL• aj>?-in_ip~l F,~:__uU~.~ <:Jj%.:_~r" caith "Si~n~hr:•a oj!',,;n iT~t ,i.~.r!%~~.: r_,J,'_,,. ,~',ir~i:is;i-~d
<br />Agent, ""Telephone Nultiber, "and "Gala" at bottom of form.
<br />13. V.`ail signed Report to Office(s) by date(s) specified i^ permit. Retain copy for yoo--ew~s.
<br />]4. More detailed instructions for use of tl•is G%sc/~ ~>~~ A:.ni!.riag R ;wort (GP.f~ °r-n ma" b- ~:b'.dn°•1 .rem C""ec(r)
<br />specified in permit.
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failwe to repot truthfully can result in
<br />civil penalties not [o 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 not more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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