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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, 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 />1. If form has been partially completed by preprinting, disregazd instruction directed at entry of that information already
<br />preprinted.
<br />2. En[er "Permittez Namz/Mailing Address (and facility name location, if different)," " Fzrmrt Number," and "Discharge
<br />Nun!ber" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. F,nter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Mzasunmznt"data for each parameter under "Quantity" and Qu,~fity" as specified in permit. 'Average" is
<br />normally arithmetic average (geor.etric averzge for bacteria] parameters) of all sample measurements for each parameter
<br />obtained during "Monitoring Period'; "Mrimlun" and A>inr.;rum" ar nomtally extreme high and low measurements
<br />obtained during "P.faritnring Parini". (Note to municipals with secondary treatment requirement: Enter 30-day average
<br />of sample measurements under 'ifvaragz,"and enter maximum 7-day ave-age of srmple meas~uemcnts obtained dur.ng
<br />monitoring period under "MQxi!nnliT.")
<br />6 Enter "Pe!-nrit Rz~uiramznl"for each pararoetc; under "Qtr1n!ity"ate d "Qus1i0~"as specified in permit
<br />7. Under "T.'-. ra" entc ~ number of sample m:asuremcnt during moni~~ ing p:r'nd th°.; e: _ecd maeim•~m (and/or mini;:r~rn
<br />or 7-.ay avenge as appropriate) permit requirement far =act; aramcte-. If none, cnt~r ".7".
<br />3. °nter "F!z~eanay o,`!n ~lysu"bath as "S~,afk ,'r1_ ~s+•ra,,;z, 1" (ccha~ f~.;quzncy of sampling amd analysis used Burin;;
<br />monitoring period) and as "Pznait 2;!!irau!an!" spcaifed it pmm;r, (c.L. F.n[er ",. ,. ,"far continuous monitoring, "//7"
<br />fcr one day per wcc!c, "1/30" for one day per month, "fi90" for onz day t:cr quarter, cic.)
<br />S. Winter "S~,a~!, Typz" botir as "S.zmp1~ iA~as!rranz! !" (acn~al =ample t;;~~ used dung monitoring pcricd) and as "Pznnit
<br />Rgur•anre.!t," (e.g. Enter "Grit" for individual sample, "2411C" far 24-hcur ca:-pnsite, 'SV/A" for continuous
<br />monitoring, etc.)
<br />' 0. ~'."rere viotaticns of nCTtit requirements arc reportrd, aGach a b. ~c"explaoa:ian Ic. r'_scribc, cause and corrective actions
<br />to be taken, and reference each violation by date.
<br />1 1. [f "np discharge" occurs during morito:in~ period, entrr'T:o P. scha-;;e" across form in nlacc of da*a erty.
<br />12. L-nter "N~,ae/Titta rf Principal T-acu[ivs G~_•," r.~ih 'SCi;;n~grr.• oJI;-i;r:;c,t °ra_u!iv~ G~_ar oj.;ul:ra-izz
<br />Agzirt, ""Telephrna Numhar,"and "Dora"at bottom of form.
<br />13. V`.ail signed Report to Office(s) by date(s) spe: ificd i^ permit. Retain copy for yoe- records.
<br />14. Marc detailed instn:ctiens for use of this D%s~l!~r;a ,L,',;!i~oriab R~r;;T (r'it.72) Form may be obtained from Office(s)
<br />specified in permit.
<br />~~~c`1 I~~~~L~r'
<br />This report is required by law (33 U.S.C. 1317;; 40 C.F.i2. 125.27). F ilure [o report cr failure to report truthfully can result in
<br />civil penalties not to exceed 510,000 per day of violation; or in criminal penalties net 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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