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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 IO hours as an
<br />average per response for some minor facilities, to ] 10 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. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office of Information amd 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 "Parmittee Name/Mailing Address (and facility name/location, if different)," "Permit Number," and "Gischarge
<br />Number' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing 'iilonrtoring Period"covered by foam where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter ".S~mpla h9zuseo'em=nt"data for each parameter under "Lrermlity"and (hraliry"as specified in permit. 'Average" is
<br />normally arthmetic average (geometric average for bacterial parameters) of all sample measurements for each parameter
<br />obtained during "iLl;ritoring Pari~id'; ".Llzrinu"n" and Nfrninnau" a-a norma[Iy extreme high and low measurements
<br />obtained during "rLlrnitor-ing Pa;io ". (1~otc to mw-. cipals ~.~ith secondary treatment requirement: Eater 30-day average
<br />of simple measurements wider "Average," and enter mex:raum 7-day average of sai-~ple measurements obtained during
<br />monitoring period under "Maximrrrr. ")
<br />6. P.ntcr "FennitR,t jt:~,em:.+t":ur each parameter uar.',• "~r.:drl~~";:net "_u,rli>),"as specified in pe:-m':.
<br />7. Under "flo rr" enter numb: of sem ile mcasurcmciu during rro.+'U in,", ;:.rind that . rcecd r;xi:num (andror mi.~imum
<br />c. 7-d_y averzgc as appropriate) permit requ~s„mai~t for each pa ~mctcr. If none, unto "C".
<br />8. Eu~cr "Fr; js~~ncy %fAnal,~ccie" troth rs "5:,:•; '• ,+~ ~ ~cr~,'-„ e,rr" (act1~1 F.cyu: icy o'sampling and analysis used donng
<br />In nnltnT+^~ per OG) aild as "~'d/„111 R,'~IPir,'r]!31 r1"S1CrIiICd in p;amit. (e.g. Enlcr ".~~.rrt,";or corti,mous monitoring, "I/7"
<br />f..r one day per v~•,rlc, "1/30" for er-e day per mnnlh, "7i90" for or.c d:ry per quarter, etc.)
<br />°. En+er "SamFL TpF~" bot'^ as "Ss,npl~ di~~u .ar,;e,;;"(s,.~nl sumpl~ type rsed during monitoring ne~iod) and as "F,:.vrir
<br />lie:loiraure,r," (e.g. inter "Gr~F" for i,tdividua! senple, '74.`!~" for 24-hci.r composite, "Ar/A" for continuous
<br />monitoring, etc.)
<br />,0. 1'Jherc violations of Hermit regturemcnts arc -cpo 1~d, zitacb a b ief t:;plc,natio~ to d_scribe cause and corective actions
<br />to be taken, and reference each violation by date.
<br />1 1. 1f "no risdtarge" occurs doing muoitora~g period, en'u "T2o Disc;-,>:rL:" across fn~n in place of data entry.
<br />12. Enter "Name/Tillz of PrinciF:rl F.. -•~rrtir ° G~~ v" wilh "Siennure of Pria~iral Esrculivz ~fficar uj A:uhorizad
<br />Agent, ""Takph;na Numhar, "and 'Data"at bottom of fomr.
<br />13. Nail signed Report to Office(s) by date(s) specified in per :tiL Retain copy for your records.
<br />]4. More detailed instructions for use of .his Dis~haree Monitoring Raps? (GA4R) form may be obtained from Office(s)
<br />specified in permit.
<br />I,e~~.l Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties no[ to exceed $25,000 per day of violation,
<br />or by imprisormrent for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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