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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 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. Envirotunental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office of Information and Regulatory Affavs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If forto has been partially completed by preprinting, disregard instruction dvec[ed at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/Mailing Address (and facility name location, if different)," " Pzrmit Number," and "Discharge
<br />Number" where indicated. (A separate form is requred 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 "Samplz Mzasurzr:eut"data for each parameter under "Quantity"and Quality"as specified in permiC 'Avzrage" is
<br />normally arithmetic zverage (geometric average for bacterial parametet5) of all sample mcasuancnts fcr cash paramete:
<br />obtained during "iLLnitornrg Pe.iod'; "ttifurimu~n" and hfiniururn" are normally extreme high and low measurement,
<br />obtained during 'iv;~,litoring P~riad". (Note to municipals +.vilh secondary trea[mLn[ requuement: ='cier 3Gday average
<br />of sample measuremenLS under 'Avzragz,"and eater naximum 7-day ave«ge of s: lple meas'.tramcnts obtained dur:.lg
<br />monitoring period under "rYiaxim:an.")
<br />G. Enter "Penair Rz~ui:zmrn" for each parameter wd~+ "Quarvliry" aid "Quality" as spcciLed '+-. ~ ~~~rlit.
<br />7. Ur e'er "; r~ L-" er.0.: rtumbar of sample mc~surcmcv' during moni:o;'n~ ,-_~~od [Let crce; -lc~r,.•v (ard,'er mini :_o~
<br />or 7=:::y avenge as apprc; riate) remit re~uiremert for each paramctcl. Ti none, a^l.; "0".
<br />II. ?nicr "r','_]rnr_f '.,'AnJI)'SlSn bath as "S~n1E I~ is •~~t"-: ra~ur" (alaLlal ir~u LCIIC}' Uf gE gp~ n~ :'7l a;`~)~5 ~5 DSCd CJflil~
<br />mOnlin ]ng periac)~~4 as 'T~rrut 27i'1lzRt1.~1" araC'~f1~Cd N !;Cm1it, (C.g..'-f.ll[CC ".".',id " rOC CJni~RUC'JS lr nnllnrillg, "l/fin
<br />for one dry par v; cc!:, "1/.30" for one day per mont;l, "//90"for one day per quarter, e[cJ
<br />9. °n(cr "Sample T;Fe" both z. "S~mpL• L~r_is±n'au•~t.1" (actual sample type usc3 du irg mo.litclir.r, r.,$d; art! , s ""•nai;
<br />Rz/ui,~.nrr„t," (e.g. L-nte.- "v. ~/" for individual sample, "?4//~" fur 2~-hear carpos~tc, "T.'/.:" fo- co ' ~+uous
<br />monitoring, etc.)
<br />]0. v;rlcre viol,lticns o.°pe~rtit ~ecv:-amerce a,e ry:erted, at[ech a brief expt+vl;,liun to i _t.c,ib, c~. ,. L1:' rn r,LSvr c'a;ens
<br />to be tahea, and reference each violation by date.
<br />1. !f"nU d1eC:lar~_° UCLV 3 during mUC'i07 n~ period, enwr "~~7U C~acf art; ]" CC r055 fC:Ti ~l'~''C l~~ti b'.: •~}•.
<br />]2. L-v'cr "N~rre/TiJ~ 'yr,°ria_iT.al E-r_utirz Gfj":.," w'th "Si;;~xr.;•.r rf /'rin_;- _ ... y, ., 'y`,-rr;ty c__
<br />Agent, ""Tel~pltonz Nre,vbe;,"and "Pale" at bottom of form.
<br />13. \:a l signed R:po. ~ to .: "-^_e(s) by dates) specified is pe~nit. Retain copy for yoe ~ __o d::.
<br />14. \?ore deG^.iled instructions For use of Cis Cis,:lurbr N%•.:ihr4lg Rz/ ... !IJL~R) rm n •r.}• :•,., , ~ . . , ,. ~•-.,-;
<br />specified in permit.
<br />LG'~'cl~ ~~®~iLIl~~
<br />This report is required by law (33 C.S.C. 131 "o; 40 C.F.R. ]25.2'7). Failure to report or f iiure to report truthfully can s,'JI ~::
<br />civil penalties net to exceed $10,000 per day of violation; or in criminal pcrtal[ies not to exceed $25,000 per day of viola ion,
<br />or by imprisonment for not more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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