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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 hotus as an
<br />average per response for some minor facilities, to ] 10 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 ofManagement and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />I. If form has been partially completed by preprinting, disregazd instruction duec[ed at entry of that information aUeady
<br />preprinted
<br />2. Eoter "Pze-mitlee Name/Moiling Address (and facility name location, if different)," "Permit Number," and "Disclutrge
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Pzrind" covered by form where indicated.
<br />4. Enter each "Paramztzr" as specified in monitoring requirements of pemvt.
<br />5. Enter "S1mplz,Llz~curenaent"data for each parameter under "~usnlity"and [iualiry" as specified in permit. 'Avzrage" is
<br />normally arithmetic average (geometric average for bacterial rarameters) of all sample men=.urements for each paraructcr
<br />obtained during ",V,onitoriug Period"; "M_rximum" and rl4i,r%;;tum" arc normally exi~cme high and low measurcTMtent;
<br />obtained during "A4%nit,ring Pzrrod". (Note to mun~ci~als ~.~i0r secondaq~ treatment rcyui:ement F,ntcr 30-day average
<br />of sample measurements under 'Avzrag~,"mid enter mc;timr-t 7-day average of s~-tplc mcas~~rcmcnts obtained durng
<br />monitoring period under "i41¢rimum.")
<br />v. F.ntcr 'Tenrdt 2.iuir~u;ant" for each parameter under "~izantity"; d "Qu,lJity" as succified in permit.
<br />7. Jndc~ "*'~~ F..•" c-~c- nvmb;.r of sample mecscreme~' during monitorng ; erod that r:ceul ma:ciman (a ir'cr mini~nun
<br />or 7-day cvc-age a/ appropriate) permit requirement for each psamcter. Ifnanc, enter "D".
<br />8. °n[er "F, ~.lu,..;_y rflra~•su"both as "Sarapl: 17eic;rrzrrzr~" (ectrrs! .re ;t!cncy of snmf'ing and mnalysis used during
<br />monita,inE period) and as "Pzn:~i! Reguirenr,.-,;1" spce~fied in nc-tit. (e.g. Toter ""art," frr coet~nuous mor.itorirg, "//7"
<br />for one day per week, "1/30" for one day per month, "1/90" far ore day per quarter, etc.)
<br />9. ~ntcr "S~m; (a Tyre" bath as "S•emols /~1~acura,rerl" (actual sample tyn;; used dur'n;; ntonitorinE period) anc as "Pz,;,~it
<br />R~:lui.zmatt," (e.g. Enter "Groh" for individual sample, "24fIC" foe 24-hau; composite, ':\'/A" for continuous
<br />monitoring, etc.)
<br />' 0. C"tore violrtions of permit requirements arc reported, attach a brief explanation to describe cause and comctive actions
<br />to betaken, avd reference each violation by date.
<br />' 1. ,n "no discharge" occurs during monitoring period, enter "Tdo );is^_hage" across fcrm in pace of data entry.
<br />12. Cuter "Nurue/Tir(e of Princi~.ll Exzcuti..: Gfjic~r" with "Sig::~!ur~ cj A•in.:iF~l F,czruli~,~e C)~azr :f Atr~hori>ed
<br />Agent, ""Tzlephonz Neunhzr, "and "Doty" at bottom of form.
<br />13.`rfail signed P.cpart to Office(s) by daL(s) specified in permit. Retain cony for your records.
<br />14, Ma•e detailed instructions for use of this Disch~;~z df,ni!ori;rg R.;-•r,t (Di1,7iJ ~o-m mzy be obained from O,Tice(s)
<br />specified in petmit.
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 135.27). 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 criminal penalties not to exceed 525,000 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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