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 fot 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 suggestio^ 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, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permiltee Name/Mailing Addrzrs (and facility name/location, if different)," "Permit Number," and "Gischarge
<br />Number" where indicated. (A separate Form is requved for each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Paramzlzr" as specified in monitoring requirements of permit.
<br />5. ?:ntcr "Somplz Mzasurzmznt"data for each parameter under "~mnlir~" acrd ~ualih~" as specified in permit. Avzrabe" is
<br />normally arithmetic average (g,:omcMe average for bacterial parameters) of ail sample rcneasurements for each pu;.T,eter
<br />obtained dmiag "rLkria,rirtg Feri~d'; ".lfasinnu;r" acrd Ivfini,nuuv" are normally rctre-rrc high and low mcas.iremcnts
<br />obtained dining "L7onito,ind Fzri;~/". ?dote?o m,u:icipJs ~~,i~ sccon.larj nca'lr:cnt rcyuirem:nt: Eater 30-day average
<br />of sample mersu:en-cots under 'A~~_ro;;z,"and cuter razzi~ .are 7-duy avc:al;a of s:.nnlc measurements obtained du.-iny
<br />monitoring period under "Maximum.")
<br />5. linter "Fe;-uric Hzluirzrne:rt"for eacS parameter unc: _r "~a.r,;ih "~... "~ualih,," as spcrifed in pem~t.
<br />7. Ur•d~r ",vo °.r" ea'c- numSer of s. Tile me~.curcment ;Iw~ng r*o it;, jog ,,crinr I'~at c:c:ad mieimum (and/or min[,nw-n
<br />or 7-_ay avenge as cppropriate; ;:emit requirement for each pa,~metcr. Ifr.cr.e, antes "C".
<br />g. Fn'er "Fr:./r~°n_y of Arr~l;~su" both s "S~,.rFlr ~LL~lsur-.~;rnf" (acts°l C.~cir..rc, ;`ccnnlin~ red .n~lysis ~,!sed C~u ng
<br />monitoring _ cried) sn~ as "Fe,»rit R~ nrir,,n_•r!" spxificd in pcnni;. (,:,g. ~n~cr "~ .,~r "for cortiouous monitoring, '7/7"
<br />f..r one day p°r week, "1/30" for ono day per month, "1/90" for one day per quarc.~, c. c.)
<br />S. Enter "SanrpL• TyF_"'oo^t as 'SS,~nafla b;e~~r; zreen'" (tctval sample t)~pe used during monita=ng period) anS as ":'srnrir
<br />Rz~uirrrrr~al," (e.g. Suter "G,vh" fot indiv2daal sample, "14H~" fur 24-hcur composite, "id/A" ('or contieuous
<br />monitoring, etc.)
<br />10. riJbere violations of permit requirements are reported, attach a brief e:plan-.tio t m dascribe cruse and corrective actiois
<br />to be taken, and reference each violation by date.
<br />1 I. If "no disebazge" occurs during monitoring period, ents "No Discharge" across fey in hr place of data entry.
<br />12. Enter 'NamzJ"Tidz ~ij Principal Fxz~rdiv~ Gfftc_r" with "Sla'n7tW'C of PriruiFal F.rscutivs O~xr of AuJtcri=zd
<br />Agent, ""Tzlephona Number,"and 'Date" at bottom of form.
<br />] 3. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Dischargz Monitoring Rep.; t (CrLfR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. ]25.27). Failure to report or failure to report truthfully can result io
<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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