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~ Papertivork Reduction Act \+); jr:'L'
<br />!, Public repurt+og burdi-n For this ,.ullut+on of information is estinmt+;d to . - ~ ~ ~.r. e, ; „,~, t !G t.,::.: es an
<br />i average per response for :ome minor Facilities, to I IO hours as an aver:+ ~_ ~, ~ i • Fe r :,,,md ^~a,;r: ;,.~Jihr~;,
<br />' with a weighted average f ~r nurp;r anJ tninur facihtiec of I B how's ),=~ ., ; ~.~~, ~ u IaJ;n_ i,n„~ for resiew+ng
<br />instructions, searching er.i•.ting Jnta sources, gathering anJ maintain.in_ ~~ ~ ,i ~'. n. rJ+~~i a:, ~ :mm~led.ig and
<br />' reviewing the collection ~~! infurnnalion. Send comments regarding ih+, i,,:.,;; ! ,• t.u~ate or :++~y othar a,pect of
<br />this collection of information, incluJing suggestions for reducing thi.+ Muder, l~ Chiel, Information Poliey
<br />Branch, PM-223, U.S. Em~ironmrnurl Protection ,4gency, 401 M Street.. SV' N':~.hing;ton, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Nrashing[on, .DC 20503.
<br />General Instructions
<br />L If form has been partially completed by preprinting, disregard instructions dir~led at entry of that infotmr[ion
<br />already preprinted.
<br />2. Enter 'Permittee Nmne/1t1ai/ing .Address (and facility namdlocalion, if ihdfcrcnQ," "Fermi( Number," and
<br />"Discharge Numher" where indi=aced. (A separate form is required for roc h discharge.)
<br />3. Enter dates beginning and ending 'Aloniroring Period" covered by torn i ~rherc !ndic:ded.
<br />4. Enter each "Parameter' ra spcci ied in monitoring requirements of pem:rt
<br />5. Enter "Sample Measuremen!" data for each parameter under "Quentin" ar J '!hr rln." in uni's specifrc.d in permit.
<br />"Average" is normal}' arithrncu~: average (geometric average for bacterial p;o:meet:.;l of aft .ample i~;:asurement;
<br />for each parameter obtaa!ed du!in!; ".Vonimring Period'; ".tfaximwu" and "t1,r:,n,n.n" arc urtntaly earerne higt!
<br />and low measurements obLtinca dining ".Ilnnitoring Period." (Noi•: t i n•:~, d;uls t+ith second:~r: treatmerr
<br />requirement: Enter 30-day average of sample measurements under "airr,:,^:•' .:nJ enter nru:~mmm 7-lay acrragc.
<br />of sample measurements obtained during monitoring period under ",i!arnmun "i
<br />6. Enter "Permit Requirement" for wch paramdec under "Quantity%' and "i~uo!,R" as specified in permit
<br />7. Under "No Fx" enter number of sample measutments during monimnn!, p:nod that e~eecd mas:~~num (and/or
<br />minimum or 7day average as appropriate) permi4 requirement Cor each parameter. !~ none, enter "0".
<br />8. Enter "Fmguency of ArmJysis" both as "Rample ,1leacurmen!" (acl!m1 Geyucnri~ of sampling wd a:~aysis used
<br />during monitoring period) and as 'Termit Requireuren!" specified in ;ern it. (c.g Enter "t'ont," f:,r continuous
<br />monitoring, "l/T' for one day per week, "//30" for one day per month. "! 70" fur ene •lay per q tarter. r: _ )
<br />9. Enter "Sample Type" both as "Sample hleasuremenl" (actual sample I+t~ usec du•n:g monitoring p: rind) and sc
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, ":r~ht"' for '1-hour cnupositc, "`d-;4" .ur
<br />continuous monitoring, etc.)
<br />]0. Where violations of permit requirements arc reported, attach a brief e~pla,:aeon to describe :dose and correcticc
<br />actions taken, and reference each violation by date.
<br />l 1. If "no discharge" occurs during monitoring period, enter "No Discharge" across form m place o"data er try.
<br />12. En(er "Name/title ojPrincipal Fseculrve Officer" with "SSgnatm•e uJF~u:crFni F.rrcuave U(~cer m."autha~.r.rd
<br />Agent," "Telephone Number," and "Dale" at boltotn of form.
<br />13. Mail signed Report to Vice(s) by date(s) specified in pernti[. Retain cop}' for yo!u records.
<br />14. More detailed instructions for use of [his Discharge ,tfoniroring Report (lLtt.4) Corn. may be ob6ttned t:om OCfice(s i
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. ]318; 40 C.F.R. 125.27). Failure tr, report or failure to n:pnrt ; vthfully c:ui
<br />result in civil penalties not to exueed $10,000 per day of violation; or in cri miml p.rnaltir~ no~ a, excr.•d $25.000 per J:r:
<br />of violation, or by imprisonment for not more than one year, or by bath.
<br />EPA Form 3320.1 (Rev. OS-95)
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