|
Paperwork Reduction Act Notice
<br />Public reporting btrrden 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. Envirortmental 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 Las been partially completed by preprinting, disregazd instruction directed at entry of that information aUcady
<br />preprinted.
<br />2. Enter "Permiltee Name/Mailing Address (and facility name/location, if different)," " Parmit Number," and "Discharge
<br />Number" where indicated. (A separate form is required for eacL dischazge.)
<br />3. Enter dates beginning and editing "Monitoring P~=ri ,,y"covered by form where indicated.
<br />4. Enter each "Param~~tzr"as specified in monitoring requirements ofpermi[.
<br />5. Enter "Sample bfeasurernznt"data for each parameter undo "Quantity"and ibrali(~."as specified in permit. 'Av,;rage"is
<br />normally arithmetic average (geometric average for bacterial psrametes) of all sample measurements fur each parameter
<br />obtainer; during "A/;nihring Period'; ",Ylsri,mnn" and A9iniurmn" ara normally cxi~,.me high and law measurements
<br />obtained durng "bl:nita,-ing R•ri~d". (Note to municipals t:-±:': secondary tcatment rccuiremcnt: Enter 30-day ave-age
<br />of sample mcasuremc,rs under "A~+~rabz,"and eu;cr rozxirnum 7-d^y average o. san;;,!c mersuror~.cn's obtaured during
<br />monitoring period under "Ivlaximu,n.")
<br />6. Enter "Pz,nit Ralui:'am~;tt" for each parameter unr'.:r "~u.nrilt~"and "Quality" as specircd;'n perma.
<br />7. L'nd_r ",\',. /'s" enter number of sample mcnsur.:rcn: during montoing p_rind i;;,11 ~::cacd maximum (a rd/er minis iu-~
<br />cr 7-dry aver 5- as appropriate) permit requirement for each parameter. ; (none, c,atr "0".
<br />8. En?er "F;~~.~~n;y :f,tnalysis" both as "S n;; l„ ,Yf•sr~rrs,u/nr" (actual `.,:quency o~sa~npling ur,d anr[ysis used d_= ng
<br />moni:ori+ig pcr.od) and as "!'~r,,,it R.z; uircur~nt" specified in permit. (c.g. Enter "~%.++,"for continuous moni*.oricg, "'/7"
<br />fc: one day per v: ceh, "1/;0" for one day per month, "1/90" for one day per quarter, etc J
<br />9. 'sorer "Sar,;Tl~ TpFs"both 25 "S~n;rl_ ALa.ur:~e,aa„!" (s^.roal sample type used durng monito~~ng period) an3 as '7rrmi!
<br />R.quira,nz.n," (e.g. Lntcr "G,nb" fur individual sample, "Z4f1C" for 24-hour crn~rpositc, "N/A" for continuous
<br />monitoring, etc.)
<br />l0. ~rVhcre violations of permit rcqucemenrs arc reported, attach a brief explanation to dcsaibc cacse and corrective actions
<br />to be tairen, and reference eacL violation by date.
<br />l I. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/Tide ~,f Principal Ex.ecu[iv~ Gffraer" with "Signahrra of Prin.•iFat Crzcutiv2 O~~er of Aurho,;xd
<br />Agent, ""Telephone Number, "and "Doti"at bottom of forth.
<br />I3. Mai[ 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 Gis~harga Monitoring Report (DM1~ form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />77ils report is required by law (33 U.S.C. 1318; 40 C.F.A. 125.27). Failure to report or failure to report truthfully can result i^
<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 tLan one year, or botL.
<br />EPA Form 3320-1 (Rev. 03!99)
<br />
|