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~s_l~erwork I2~~'.~..ya~ _:; Act Notice
<br />Public reporting bwden for this co]Icction of information is estimated to vary from a rattge of 10 hours as an
<br />average per response for some minor facilities, to 110 haws 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 ittstructions, searching existing data sowces, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of infotmation, 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, BC 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 aUeady
<br />preprinted.
<br />2. Enter "Permittsz Nan:e/Mailing Addrzss (and facility name/location, if different)," "Permit NumFzr," and "Dis~harg~
<br />NumEer" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "tdc,ritoring P~ricd"covered by form where iodica[ed.
<br />4. Enter each "Paramrt_r" as specified in monitoring requirements of permit.
<br />5. Enfcr "S~mplz ,t!_arurz.nant"data for each pazamctcr under "Qtranti[) "and Luolih "as speci led is pe~rrit. "Ar, ~;°a,;z" is
<br />nornally arthmetic average (geometric average for bacterial pa,~meten) of all samgtlc mcastrements for each t~arametcr
<br />obtained duri„g ".til,.:hsrin„ !'mod", ".9_ainnun" aid ii,ini;,rum" a-e nomally c:tv.nc high and !on' mcasu moments
<br />obtained dmitg "`n,'.rir rir;,;,^zri-d". (Note to m_n~ci;:als v;ith sccendan,~ truatmc~I -r;circmcnt: Eater 30-day avc .g~
<br />of srmn;e mcaswemcnt~ u~Ler "Avzr_~ba,"end cntrr ~.:::imurr 7-day average o~ sample mcasurert_nts obtained dw-irL
<br />monitoring period under 'SLfruimun..")
<br />5. 'irtcr "!'z~ n.it h. pr.'r~rnr.tt"for each parameter undt' "~;r~n!%IV"and "emu lily"as ;pcci~cu ~n parmi'.
<br />7. Und:r "A',: F..-" enr:r numbs of sample mc: ~wement _.rng r:n-'±o ~r0 nc~nd tai: t c•:cced rna::`mom (ccd~nr minimum:
<br />or 7-dcy acct;,, a; .,riproprt[c) Hermit re~~ircm~nt ;r cadr paramdr.;. ii none, n,tcr "0"
<br />P.. ?ut_r "F rd; •sn°1• ~,f~;;rllpsis"both as "",;a; r• dr.: -: •, 'r.,;d!" (, rniel frceucncy ,~'sam~lir,g ;nd ,uraly:is used d~_~•i,rg
<br />monitoring ntr;,rd) end as "F's,~,air,2•;~rir.,r •n!"snc::il?~d in f.cmtit (c.g. i=~,tcr ". ~.ot,"fe~'con'i~~mo~: meni,orin^, "t/"'
<br />for one day pew wx':, "1/.40" fur ane day ter month, "//90"for one day p;,r quarter, etc.) u
<br />~. Enter "Sorrj d • Tyr •" boot as "Sa,n,-!e b;.:. ru d„re,v" (r_tual smn~lc tylx used drr r~ monitoring period) an:] as "T sari!
<br />RR7rir~m~nt," (c.g. ^nter "G;~h." for ir.di;idual sample, "14r/~" tar 3d~hc!r cr,mrositq '-tr/~"' for Conh-,coaa
<br />monitoring, etc.)
<br />10. \'~"ter violations ofpetm+t reduiremcnts arc rc3ortud, attach a h-icf explcnation ro d_sctibe cause and corrective uctons
<br />to be taken, and refernce cacti violation by date.
<br />11. if "ro dischuge" occurs durJ•g monitoring p:;rind cola "No D~.char~c" across form in place o; data entry.
<br />12. F.nrer ';Yom~/Titls cf Princira! Exzvtivs Gff._ rvirh "Si;rrrtrn, rj r7%r,,ri/~' F_xu_tr;ir: 0~,~~r of Authw•iz.td
<br />!gent, "'Tzlrphoru M, umFzr, "and "D~ts" at bottom of form.
<br />13. Yuil signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. ~Icrc detailed instructons for use of this Gisc;rJrgz A1,xitorurg Raho;7 (Cr;~ form may be obtained fivm Office(::)
<br />specified in permit.
<br />Legal Notice
<br />This report is required bylaw (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully ca*t result in
<br />civil penalties oat to exceed $10,000 per day of violation; or in criminal penalties dot 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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