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Paperwork Reduction Act Notice Public reporting burden for this collection of information is estimated to very from a range of l0 hours as m average per response for some minor facilities, to I10 hours as an average per response for some major facilities, with s wrighted average for major and minor facilities of 18 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing; [be collection of information. Send comments regarding the burden estimate or any other aspect of this collt~ction of information, including suggestions for reducing this burden, to Chief, Information Policy Branch, I'M-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of hfanagement and Budget, Washington, DC 20503. General Instructions 1. If form has been partially complet;J by preprinting. Disregard instructions directed at entry of thaturformation almaz.y proprinted. 2. Enter 'Permlttee ~1'ame+:Lfailmg Address (and facility _tamellocation, if diBerent)," "Permit Number," and "Discharge Number" where indicated. (A separate fomr is required for each discharge.) 3. Enter dates beginning and ending "bfonitoring Period" covered by form where indicated. 4. Enter each "Parameter" as speei~at in monitoring requirements of permit. 5. ?nter "Sample AAeasven.anr" .ata for rach paramelz~ under "Quantity" and "Quality" in units specified in permit. "average" is normally ariihrnciic average rgeomctric a+er;e for bacterial parameters) of all sample measurements For each parameter obtained d.rrmg "Monitoring Pcnnd"; "Naximunt" and "Minimum" arc normally extreme high and low measurements obwin:d dunng ",Llnnitormg Pe~,~d." (Note to municipals tsith secondary treatment regmremcnt: Enter 30-day average of simple mcawremeuts under "Average," and enter maximtun 7<fay average of eample measurements ob+ar.ed during monitoring period under "Maximum. ") ti Entet "Permit Requirement" foe each parameter ~!.tder "Qunnrity" and "Quality" as specified in permit. 7. Under "No Es" enter numhe. of sample measurments during monitoring period t}at exceed maximum (and/or minimum or 7~ay average az arpropriatel permit requirement for each parameter If none, enter "0". 8. Enter "Frequency oJAna!}•sis" bot;r as "~nmplr .Lleasunnent" (actual frequency of sampling and analysis used during monitoring period) and as `Permit Requu•etnent" specified in permit (e.g., En[er "Conn," for continuous monitoring, "1/T' for on: day per ,veek "I 3t7" ter one day nor month, "1+90" for one day per quarter, etc.) 9. Enter "Sample Type" both as "S'mnnle Aleasu,rmen:" (aciral sample a•pe used during monitoring period) and az "Permit Requirement," (c.g., Emc. "t;"oh" Cur individual sample, 'r?al!("' for 23-hour composite, "N/A" for continuous monitom~g, etc.) 10. Where violations of pernir requirements are reported, at4~ch a brief explanation to describe cause and corrective actions taken, and reference each : tolalion by date. 11, If "no discharge's occurs during .n~•aitoring pernd. eutar "N.. Discharge" across form ir. place of data entry. 12. Enter "A'ameifitln oCPrincipal ExacuGve OjJicer" .vtth ".1';gnarure ojPrincipal Executive O~cer ojAuthoriied Agent," "Telenhnne :Vwnber," and "Bate" at botiom rf form. 1 J. Mail signed Report to OfSce(s) by date(s) specified in pernd. Retain copy for your recrords. 14. Mun: dciailed instructions for use of this Grsc~a_er ,4fomto.-ing Repcrt (DM.'t/ form may be obtained Crom Office(s) sperSed in permit Legal Notice This report is required by law (33 U.S.C. 1319: 40 C.i• rt. 125.Z?). Failure ro report or failuro to report truthfully can result in ci'+il penalties not to exceed ' . J,000 per 4ay of vtclatir+r.; or in criminal penalties not to exceed 525,1100 per day of violation, or by imprisonment foe not more th°a mne year, or Sy both. EPA Form 3320-1 (Rev. 08-9~