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~~~~~~rwork Re ~~ctio~1< 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 far 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, 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 ?vI Street, S.W.
<br />Washington, );C ZC460; 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, disregazd instruction duec[ed at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/Moilinb Address (and facility nameAocation, if different)," "Permit Numbzr," and "Discharge
<br />Numf~r' where indicated. (A sepazate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "P~ro,n:lzr" as specified in monitoring requirements of permit.
<br />5. 1;nter "S-rmF/z i.ie~uur_m_nl"data for each parameter under "Qe:mrtity"and [iualih "as specified in permit. Avrraga" is
<br />normally arithmetic a~~erage (grorrtetric average fnr bacte~al parameters) of all ssrrtpic measurements for each parameia
<br />obtained dm-irg "i:;-•nitoriu~ T„riod'; "iv;lrimunr" and ivli:ri:,,;nn" are normall}• csrrcme high and law mcascrema+~s
<br />o i7tairc~~ during "1•r•.,rir .,-inr; Frrioa". (1\'ntc to municipals w.iih secondary n~catm ent rryui-em ent: Fnter 30-day : ve~a;;c
<br />of,uvn;+!c mcasrremcnts under "Aee,vaa,"and enter mz.imum 7-day average of ar_mpL muasurcmcnt, obtained d~-i,,g
<br />monitoring period under ",t'ilrinru,n.")
<br />u. Erg - "?e,-,;;i! /c :; rirs,;; sr:'" for eacb parameter under "~ua,rtlr,,'r.nd "Qre>li.~~"as spcci icd in pc~~rti•_
<br />7. lir,der "iJn ><'c" enter num;,c: o'sumple m:csuren,cn: dining rnonilonng perod t1+r' _,cead ma>,immn (mrd/ur rnitimum
<br />or 7-ray aca roc ;~, appro~tiate} peg ~r.ii rcquirc:ncm for each parameter. if none, cater "0".
<br />fi. .:._ "F,--, .:r.,. ~.,~.irvijsis" boor a, "S~m; lr :o-; -, sar_,v_,;t" (actual irarue,~cp ,,; scrap ~~~ and analys'.s ,used d~~~in~
<br />monitoring xro~i a"c as "I:Tait Fe_pvir~,,uri"specified io pcrtuit. (e.g. nter '~ rt." rrr continuo s n oniioring, "//7"
<br />Cer anc da}• ;.e; •.vec::, "//30" ~o: one d,~ per month, '7/90"for one day per quarter, etc.)
<br />,. :~;,ICr _~„~f.. ;~ z" both as "S~;nflz ~..e!aar:;urn,'" (actual sam,'e type u;cd dur:ug• tnoni[oing pcrod; and as "P.rn,rir
<br />F(1,1DlY..il~'at," (cg. L-nter "tarot" for irdividucl sample, "1411 ~"' for 24-hour wrnnositq ".\~/i" for ccmir.uous
<br />monitoring, etc.)
<br />;0. V/'acre vinln uva; of permit requirements an r_porieci, attach a brief ezplanatien to ~cscribe cane rnd eo-Tee.ive cc'~uns
<br />to be taken, and reference each violation by date.
<br />11. ?f"no discharge" occurs during monitu,ng period, eater "i~o Cischarge" across form in place of rata entry.
<br />12. corer ",Vu,n~'/Tittt c,~F,tir_i/~_d B•xutir~ C>;<_~," tvilii "Silrrzuu~ ~j,~ri,uil'].' Exe~niv~ G~icz,- ojArrl.,.,rzzc!
<br />figdnt, ""TelzFlr-..r ~ Nunil•e,•,"nod "Catz" at bottom of form.
<br />l3. iJail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />pure detailed instructions for use of this Disch~rg,: ,Lluaitoring R.p~,7 (D,1:I~ form may l;e obtained from Offce(x}
<br />specified in permit.
<br />Legal Notice
<br />T1tis report is required by law (33 U.S.C. 1318; 40 C.F.R 125.27). Failure to report or failure to report tnrthfully 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 imprisonment for not more than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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