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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 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 IS 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 reduc;ng 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 has been partially completed by preprinting, disregard instruction directed a[ entry of that information already
<br />preprinted.
<br />2. Enter "Permittea Name/Mailing Address (and facility name location, if different),' "Permit Number," and "Discharge
<br />Number' where indicated. (A sepazate 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 specified in monitoring requirements of permit.
<br />5. Enter "Sample hfeas:»•ement"data for each parameter under "Qironlity"and Quality" as specified in permit "Average" is
<br />normally arithmetic average (geometric average for bac:.rial parameters) of all sample measurements for ezch parameter
<br />obtained duruig "A~onil~ring Period", ':'d~imc,a" and tifini:nu/n" are normally extreme high and low measurements
<br />obtained during "i~lonitoriag Pe;;~,J". (1Qoie to municipals i~~itl/ secondary treatment roquircmcn:: Enter 30-day average
<br />of sample measurements under 'Awr age," end cute; r, azimcm 7-tray average of s_nplc measurments obtained dur;; g
<br />monitoring period under "i/,zrir,:um.")
<br />6. Enter 'Pet-r»it Re;nrireme,a"for ~. ch p<r. m.,er rnd _r "~r.,»tity"; nd "yv~tity"as specified in permit
<br />7. Ur_cr "/~//!'s" e .te: rumb.r cf s:.~pl: m:,-~: rer~ 'during monitr-'~o ;eriod that er teed mz:imam (ant/or mini-..m
<br />or 7-ray zv.:ru„e as appropriate) pencil ;.; uircmcr: fur each parameter. lfnone, enter "0".
<br />II. ?ntur "I',,r7uor~y oj`.'.»_,/p.;is" bor_h r, „ ,. /,-I' i../, n,,: ~,,::..." ;ectaal G.erncy of s_^pling sd analysis used during
<br />monilo~ing period) and as "FeIT,L'! r~,ar/,'~/, •; "S,te- tied Ili pl'I'nlt. (~.~. ~ntei "~O.Ii,"far COntmWUS mCmiORR„ "i/7"
<br />for one dry per wce'c, '7/?0" for one da, pay monPi, "I/90" for one day per quarter, etc.)
<br />9. Enter "S~mpk T•T~"bath as "S_r,.>.~.1: ;.:...,/~, _•:~ s, '" F.c:url sample type used during monitoring period) and as "Farb;
<br />R.>:tui~znre,rt," (e.,;. Enr_: ";,r_~F" for iadividu:l son plc, "14i1C" far 24-hour composite, 'SV/A" for continuous
<br />monitoring, etc.)
<br />10. P.>>lela violations ofpennif recr•i-~ncnrs sic rz, or'ed, : L'rc:r a b,iefexplanation to desc/ibe cause and corrective actions
<br />to be taken, aid reference each violation by date.
<br />11. If "no discS•arge" occurs during ~ror'tc~n;; r;e`c;, e.r'_r "1'o':'scii"rge" across form ul place ofdata entry.
<br />12. Enter "N~nre/Titls •~~'.^;~ilr;:iF:! ,i-.:,~tii•~ r j~~ ., ' ~~'r'~ ".SI~~I~'L:-s Lj Pri».:ifat Er: vrive i~c~er of Au6i-.,-%r. _t
<br />Agent, ""Telex 5o;:e Nr/,nhe, ; "and "Graz" at bottom o f fc ~ in.
<br />13..v?ail signed Report toC~.xc(s)by;_t s;speci°ie: i,~;:,,~~dt. retaincopyforyourrecorcls.
<br />14. More detailed instructions for use o: G,is /';:~_irr,~u iv~•.nirori/ro R ;r-,,7 (I`,L>7ZJ foml may be obtained from Ci",~cc(,)
<br />specified in permit.
<br />,r~-~~ I
<br />Tbis report is required by law (33 U.Q.C. 131II; 40 C.['.R. ]25.27). Failure to report or failure to report truthfully can rosnlt it
<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 not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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