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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, 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. Envirorunental 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 duected at entry of that information already
<br />preprinted
<br />2. Enter "Pernrittee Name/Mailing Address (and facility name/locatioo, if different)," "Permit Number;' and "Discharge
<br />Number' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Nfoniloring Pericd"covered by form where indicated
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample tY/~~~sm•ament"data far each parameter under "~iuantiry"and/_hroliry" as specified in permit. 'Averabe"is
<br />not tally arithmetic average (geometric average for bacterial parameters) of all sampL measurements Cor each pzrzn;e'ier
<br />obtained during "i/aril~ring Period'; "lvLuirruun" and ~Lfiniontnt" are normally extreme high and low measurement,
<br />obtained c:ur~ng ".'v.'cnitor ing Peri,~/". (A?ote to municipals wide secondary trcermert requirement: Enter 30-day avc~.age
<br />of strnple me.~suremrn(s under 'ilv,:r~s ~,"and enter ms:;imum 7-day av,:rage of srmp?c measurements obtainer dmino
<br />monitoring period under "Maximum.")
<br />G. F,n,cr "P~rmi! R.aarr!r.mant"ior each parameter under "nu_ntit)~"and "~ualiry"as specified in pern*t.
<br />7. Under "i• ~, Ls" enter nw-nbcr of sample me~su'::mcn[ during :nunitoring period that ctccrd maximum (and/or mi,-'mum
<br />or 7-day a••cngc as appropriate) pu.mit requirement for each parameter. If none, e~tar "0".
<br />~. ~~ 'C; "Pr;ar_ac~ cj ~Inalpsis" both as "S~r,rFl ,il _~sur~~nr .,r" (achal f-cqucr.cy cf sampling and analysis rued during
<br />monitoring period) and as "Per.nit 2_tu4•e,nen(" specified in j..r~tiL (e.g. Enter "C•.,r:,"for conRnuous monitorin;;, "1 /7"
<br />for ore day per wee!c, "!/30"for one day per mon'~it, "1/90" for one day per quarter, etc.)
<br />^>. °.nlcr "S~.rf•(s TyFa"both as "Slrnple bf„astr,~+n~ni"(actual sampl,; type used during monitoring period) and as "Perrrir
<br />R~guir~nranl," (e.g. Enter "Gra,~" for individual sample, 3dHC" for 24-hour camposito, 'i\%A" for conr.'nuous
<br />monitoring, etc.)
<br />10. 1Vhere violations of permit requirements are reported, attach a b:icf cxplanatia^ to dcsc,ibe cause and corrective aclions
<br />to be taken, and reference each violation by date.
<br />11. If "no Discharge" occurs during morti[or'ng period, entcr'RJo Discharge" across form i^ place of data entry.
<br />12. Enter "Norm/Title of Principal Exscutne O~•_•er" with "Sigrratur~ of Prirtaipa! E.CZCnIlYB Officer of Authorized
<br />Agent, ""Telephone Number, "and "Date" at bottom of form.
<br />13.:vlail signed Repoli to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />4. Vlore detailed instructions for use of this Discharge 1Llcnilering Report tD~ form may be obtained from Ofiice(s)
<br />specified in permit.
<br />Legal 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 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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