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<br />?ublic reporting burden for this collection o'' information is estimated to vary from a range of ] 0 hairs rs an
<br />average per response for some minor facil rics, to 110 hours as an average I.er °esponse '.o. aor_~ sajo=
<br />facilities, with a weighted average for majcr aud.:~inor facilities of 1>3 hours pe_ response, i;t°llding tame fo=
<br />reviewing instructions, searching existing ~1ta sources, gatiering ann maintain'ng the data ,_~eded, and
<br />completing and reviewing the collecrion o.';nfoL~nation, inc_t~.ding suggestion for red~!cing t;ti, bt.~rde~, to
<br />hie ;Information Policy Branch, P:v~-22 J.B. Environmental Protection F•.gc~cy, 40: il•~ ~tiect, ~.'v1t.
<br />~dashington, DC 20460; z-td to the Cf'ice c"`sformation and Regulatc.y f~~`fairs, :;ifice of i~ia~age,!ent 2nd
<br />Buriget, i~lashington, BC 20503.
<br />..-.:Y. ... .. .n. ...V v.1 .L. v~:... J.... L%
<br />1. If form hzs been partially completed by p . ;~ Wring, disregard instruction directed at entry of tha_ ~nfc:mat on rlrea~
<br />preprinted.
<br />2. Enter "Per;,rittee Name/Mailing Address (:.:1`acility name location, if dif`.~t)," " i"d,Tirit ArrnnFrr;' and "Di.:cha;oe
<br />Nunher' where indicated. (A separa.:, form s -equired for each discharge)
<br />3. Enter dates beginning and editing "ivio. ~itor.~~ Per%cd"covered by form c+rere ird~caled.
<br />~. Enter each 'Poramete,-" as specif ed in mon::or-ing ;x;quiremcnts o''permi'.
<br />5. Enter "S!mple Measrrremenr" data for c-ch azmcter u-der 'Qua, ti;~" an~: Quariry" a.¢ ; :ecified 'n :.mit. ' 'va •_ge" .,
<br />normally arithmetic average (geometric avc.age for'~.cterial parameters) cf all samp'e me uremrn-s I'o; ea. Pa ametc
<br />obtained during "ionitoring Pe:ion{'; "iv./.•ri,.ru,n" and lvinirtur,; arc no~7n_lly eztre:ne high ; mi irq~ Gl_~Sl`.~L 1;.;
<br />obtained during "Monitoring Period". (i`?otc to municipals eri[h accondar,• Lc~tmect reL.:iremcat. ter.:c. 30-cay •verr~:
<br />of sample mezsurements under "Ave. age," and entry maxir^um 7-day av:rge of sample measure -: to ab r=rec dc-`i;;
<br />monitoring period under "idaximum.")
<br />G. Enter "Penait Require ,Went" for each par,.m: er under "Oua, tiry" and "Quality" as sp-cif ;d in permit
<br />7. Under "No Ex" enter number of sample mc..;wemeat during monitoring period [hat .rxc'ed maxiL-n. ;czd,'c m_:u~t: n
<br />or 7-day average as appropriate) pe!7nit regrirement for each pazameter. If none, entc r "0 ".
<br />3. Enter "Freguenc~~ ojAnalysis" both as "Sa ple !/•easuren, zat" (actual firgccncy of sa.-tpling ar ~ • r vl sin sec duri.i;;
<br />monitoring period) and as "Perr;rit Requirer..znt"specified it permit. (e.g. Eater "CoN,"for continuer r .roa~lcrn;, "1/."'
<br />for one day per meek, "1/30" for one day pc. month, "1/90" for one day pc- quarter, etc)
<br />3. Ente_ "Srn:rple Typz"both as "S~nple ideas^remenr" (zctua sample type used during monitoring p:; ; ~d) arc as 'Perm!
<br />Requirement," (e.g. Enter "Grab" for im ividua] sample, "14HC" for 2A-hour composite, "~,;,.' fo: cortinuous
<br />mostoring, etc.)
<br />IC. \tVhere violations of permit requrremcnts a : reported, attach a brief exp]aaation to des~be cause a<a: ournc'ive actions
<br />to be taken, and reference each violation by sate.
<br />1 ]. If"no discharge" occur; during monitoring _isriod, eater "No Discharge" across form =n place of data c dry.
<br />12. Enter "Nome/Title of Principal Executive Office " with "Signa[ure of Principa! Frecutive t~ce,• of Aurhorizad
<br />Agent, ""Telephone Number, "and "Date" at :ottom of form.
<br />13. Nail signed Report to OtTice(s) by date(s) spxified in permit. Retain copy for your r words.
<br />lei. More detailed instructions for use of this i~ischarge ldoniroring Repor! (Di.92J fo 7n may be obtzired from Cf~ice(s)
<br />specified in permit.
<br />This report is requved by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or fa ere to report ttuSrfu[ly cnn result in
<br />civil penalties not to exceed $10,000 per day of violation; or in criminal penalties not to exce;~cd $25,000 cs day c`viclatie~
<br />or by imprisonment for not more than one yeaz, or both.
<br />1uPA Form 3320-1 (Cdev. 03/99)
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