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Paperwork Reduction Act Notice
<br />Public reporting burden for. [his collection of information is estimated to vary from a range of 10 hours as as
<br />average per response for some minor facilities, [0 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours oar response, including time for reviewin~-
<br />insttvctions, searching existing data sources, gathering and maintaining the data needed, and completing and ~ i
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of informer on, including suggestions for reducing this burner., to Chief, Infotmratiod Policy
<br />Branch, PM-223, U.S. Environmental °rriection Agancy, 401 M Street, SW Washington, DC 20460; and ~o [he
<br />Office of information and Regulatory Affairs, Office of ~.i:.nagement and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has barn partially comnl. t;;d b}' preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permitter Kma~~.llod~np Arldrecc (znd facility narne/laalion, ,f different)," "Permit Number," and
<br />"Uischnrge Number" whrrc mdicatid. to separate form is required for each aiscitargeJ
<br />3. Enter d.nes beginning and end:n~ '3:~ni;oun,~ Perod" covered by form where indicated.
<br />4. Enter aach "Pnronu•ter" us spa :;'.:d in r.,omtorirg rcquircments of permit.
<br />5. Enter ".Sonrple 1;ei:,ur_•urenP' da+~. for each parametFr under "Quamily" and "Qrnlitt" in units specified in permit.
<br />".'+•crngr" is normoll~ arittuuct~c .:.er~gr (geometric aver,:gc for bacterial parameters) of all sample measurements
<br />for each paramde: ob~;inc' d+rrg ",11nm:oring Period'; "11axm;mn" and ",1lbrimum" arc normally edreme high
<br />and low measuremenu ob,arte; during "tirnitcri.:~ PerioJ" (Note to r,runicipals wish secondary treatment
<br />rcquire-ncne Enter lU-d a+ av_raec of ::~nrpi•; rneatnrcmcr.!s under ".4rerol;e." and cntcr maximum 7-0ay average
<br />of sample measurements ob+ain.: ~ iarmg mon~ter:ng period under "A.larbru:nr. ")
<br />6. Enter "Perrrut Requires;. nr" far each p.arnnn_ter under "Qun.~uiry" and "Quo/ rt" as specified in permit.
<br />7. Under ".Vo Ex" rater number ct s;:n~:ple mcasunnents during monitoring i,eriod that exceed maximum (and/or
<br />minimum or 7-0.:y aceragc ; ; a;mtopriate) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequenct .>j :inal:~ers" F.ntil s "Sn.uple !.Iro.rurn;ent" (actual Frequency of sampling and analysis used
<br />during monitoring period) and ar ':~ermir Requirenrenr" specified in permit (e.g., Enter "Conn," (or continuous
<br />menitori,tg, "1 '7" for r nc day prr ~~+xk, "1 30" for one dny per month, "/-90" for one day per quarter, etc.)
<br />9 Enter "Sample 7tpe" ta~h a. `: arnp;e 1feaureuren:" iacrual sample t}'pc nscd during monitoring period) and as
<br />"Permit Requir:menl," ie.~. F.a'.r 'Drab" for i°;ividuai sample, "?JHt"' for 24-hour composite, "N/.4" for
<br />continuous monitoring, enc.)
<br />l~. Where violations of perrnit re~loiremcts arc rep•.,., d, ava-1, a bric(e~planation to describe cause and corrective
<br />actions taken, and reference eaci• violation be date.
<br />1 t. If "no discharge" acurs dern€ n caitcring period, "plan "No Discharge" acror form in place of data entry.
<br />12. Enter "\'cme.Tid~~ ojPr;ncrpr.! L:;eculivr Q:Jicer" ,+ith ':?iXualure ojPrincipnl Executive Officer ojAulhorized
<br />Agenr," "Telephone Number " ana "Dale" 2t bottom of torn[.
<br />13. Maii signed Report to Ofi ice(s) b; :L^.te(s) specified in permit. Retain copy for your records.
<br />.4. 1•t~re detailed iru'~.rctiens for us: 'f this Dsr!rar~r• 'foniror.ng Report ~PA!R) form may be obtained From Office(s)
<br />specified in permrr
<br />Legal Notice
<br />'T'his report is required by law (33 U.S.^. 1318; 40 C.F.;t. 125.27). Failure to report or failure to report truthfully can
<br />rea:ult in civil penahies not to excr:d 210,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for ^ot more .hap one year, or by both.
<br />EF'A Form 3320-1 (Rev. 03-95)
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