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Pape;r•ivork Reduction Apt Nf-~'i(:~e
<br />Public reporting hurdrn '~~:=this .i.!naton of in f~rnration is estinratrJ ~ ~ ^.r., 4 ~-~ ~• ~ ..,....~
<br />' average per response tur rc.ne r.,: ~ 1 ~,ilities, to I10 hours as an aver,;, - ~ i .. f•=r .,re r.::r;n~ ta..ilrrir:.,
<br />' with a weighted average fur m.x;,.: ~rv' minor fuihtias of IS hours fcr r ~_: ~ ~ iuJ. = :i.r; +or r~~izwiug
<br />I instructions, searching exr.ting ~. I .; ~ccs, Satherin„ ~-.C ~ •intautin; I; ~ r ~ t~•,dnl, .emu! wmplatiog ar+d
<br />reviewing the collecliu^ ul~ infornW~,.on. Send cc.~mments r-,.:riling iha hu dc~: timatr or any other uspect of
<br />i Ihis collection of informtuon, in.:uJ.ng suggestions Fur reJucia~ this ~~~.. r!. :. .- !'hL:f, Ir.fornralicm Policy
<br />Branch, PM-223, U.S. En.lronmrn!r{ Prntectiom i\gency, 401 'A Strz:a, ,ill '.1,:::h~urgton, DC 204b0; and to the
<br />Office of Information and Regulatcr; .+ (fairs, Office; of Management and 8u~. err, R'aehington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard ins[nrctions cin.ctcd at entry of that information
<br />already preprinted.
<br />2. Enter "Permittee Name%1~lailing Address (and facility mameJloption, if drfTercnQ," "Perini! IJunrber," and
<br />"Discharge Number" where indicated. (A separate form is required far c+ch d+scharge.)
<br />3. Enter dates beginning and ending ".llontmring Period"covered by fo,mr: where +ndicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of pcnait.
<br />5. Enter "Sample bfeasurenirnP' data for each parameter under "Quonun ' tnd "'h..~hr:" in uniLu specified in pernut.
<br />"Average" is normally ari:hmcut a:~crage (geomrlric average for bane nl par;rn; Icr~:) of a!I ;ample measurements
<br />for each parameter obtained du~n_ "dlanitnring Period'; "blaxinnnn" • rd "1'ruurw r" .tic normally e.arcmc high
<br />and low measurements obtai~cl during ".monitoring Period." Q~u~,. tc.:r,,n::peiti with ;econd.~rr trcauncw
<br />requirement Enter 30ii:,y avcr.ge of sample mcasurcmenls under '.I -vrgGe,' :u~d enter maximum 7~iay av°rs€;e
<br />of sample measurements obtained during monitoring period under ".ilwirnu~n. "r
<br />6. Enter "Permit Requirem<•rrt" for each parameter under "Quantity"and "s h.a:nv" as sl~ec+tied in pernut.
<br />7. Under "No Ex" enter nw-+ber of sample measurments during monitoring pcncxJ ;!~•rt exceed ma~unum {andlor
<br />minimum or 7~ay average as apFropriate) permit requirement for each pain ~te•er. If none, toter "0".
<br />8. Enter "Freguenev ojAnaiysis" Loth as "Sarnple Afeasvrment" (ach..al 'n: ;tierce •d samplin; ;tnd u~ialvsis used
<br />during monitoring period} and as "Nennir Requi"enrenP' specified in f _~ a d. (e :; uucr "C one," foe continuous
<br />monitoring, "1/7" for one day per week, "1/30" for one day per month. ", '~!r' for oce day per grarter, er: )
<br />9. Enter "Sample Type" bosh as "Sonrple,tteasurement" (actual sample rp~ i;ed du;inr monitoring 7_iod) and as
<br />"Perini! Requirement," (e g., Enter "Grab" for individual sample, "_'.Hi„ far t-I-hour composite. ";V!1" Coe
<br />continuous monitoring, etc )
<br />10. Where violations of pernut requirements are reported, attach a brief explanation to describe cause acd corecrrre
<br />actions taken, and reference each l iolation by date.
<br />1 L If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data e; tn.
<br />12. Enter "Name//'ille of Principal F_rerwrive Dicer" with ':Signature vj rnn.crpni (isrvlire U~~reer ,r•`:turhori_eri
<br />Agent," "Telephone Number," and "Date" a[ bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit Retain copy for your i ecords.
<br />14. More detailed instructions for use of th+s Discharge bfoni(oring Report (1! 111'.1 torn may be obtained Gon: Oflice(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report err Frilure Io report +~uthfully c:u:
<br />result in civil penalties not [o exceed X10,600 per day of violation; or in criminal x'ualti ~s no' to exceed 52`,000 per eay
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320.1 (Rev. 08-95)
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