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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 ] 10 hours as an average per response for some major
<br />faci]ities, with a weighted average for major and minor facilities of 18 hours per response, including time for
<br />i reviewing instructions, seazching 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 and Regulatory AtTairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction dvected at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/Moiling Address (and facility nameJlocation, if different)," "Permit Numher," and "Discharge
<br />Numher" where indicated. (A sepazate form is required for each dschage.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Paramatzr" as specified in monitoring requirements of permit.
<br />5. Enter "Sampiz cblz~surrnrznl"data for each parameter under "Lnrantiry"and Quality" as specified in permit. "Aver~„e" is
<br />normally arithmetc average (geometric average for bacteria] parameters) of all sample measurement for each pt~~ aster
<br />obtaineil dining ",t;:nitoring P~•riod"; 'S14;z*imum" and tilinimuur" are normally c;a,~cme high and low measurements
<br />obtained during ':Sf,rritc; ing Pdri~d". (1Qote to ~.L:icipals with sceonda,y treatment ryuircmcnt: Enter 30-aay avc!aga
<br />of sample mccsuremcnls ender "Av.raKz,"ar,d enter n, cimum 7-day accrage oFsrmplc mcasurzmcnts obtained du~iir~
<br />monitoring period under 'SYlaximurr.")
<br />6. Enter "Prnnit t7~~~ui, arr,:,V" for each pan~meler un~ _r "~ ~~ o,tiq'"an_' "Q~raliN"as specified in pem~t.
<br />7. Under'7~/r T:c" enter nember vi sample mec;arement dw~no mcmitorin~ period .I^rt c:cecd ma~,imum (r.nd,'er mir'~a:ca
<br />or 7 dcy avera~~ as rppropr.ate) ,-.er~nit rcrluircmcit for each pacuneter. if none, enter "0".
<br />B. °.n`-cr "Frz:;:•~n_y cf f6r~lysis" Loth es "". ;; r, r_ Al ~.rcur~s:;r_nr" (actuzl frquc^cy o"sampling and analysis ~sed d~a~:~g
<br />monitori~;g per:od) : nd as "P.,-„ri! R_.,rzri~ _ ms,~~" s~~ecified in pcnn~`. (c.g. L•ntr-r "~~,nt. "for continuous monitoring, "1/7"
<br />fur one day p;r v: zek, "1/30" .ur cer, day per mont;t, "!/90"for one day per quarter, etc.)
<br />4. Enter "S~rr/1s TyE _"bot'r rs "Sl„r! i_ ,L,'_~a.:~s,ae, ~!"(zch~al sample fjpe used duri~tg monitv~:ng ncrivel) en_ ; , "F:n;rit
<br />Reyuir~~n~,!r," (e.g. Enter "Grate" for i,rdi~idual camp!., '74N:" fur 24-hour cumpusite, 'SV/!," fcr ca ~ ~vous
<br />monitoring, etc.)
<br />]0. !'!here violafruns ofpe:mit requiram:;~~t; are rpcrtcd, attach a bricFezp`anatioa to dcscrittc cease and cnr,~.;r.we r.:'.:..;
<br />to be taken, and reference each violation by date.
<br />11. If "no discharge" occurs d~-inp, mcu'toring pzrioc'., en:er "No Discharge" across form in place of data enby.
<br />12. Enter "Name/Tifl~ of Fr6rcipsl Fxxutiva Gfft,;_r" with "Sisatattn•t cf Prin:iF~l Exsculiw_ O~~~r rf r'r'h~. i- :/
<br />Agent, ""Teleplr~ne Nurrhzr,"and 'Cate" at bottom of form.
<br />13. 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 Cis/t~rg.: M» rit~ring Report (D,L1R) form may be ohlaine3 frem Cf Gc:(~)
<br />specified in permit.
<br />~eg~.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 in exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violativn,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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