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~ Paperwork R:eduction A-ct N~clt.il.e
<br />Puhlic reporting burden f..rr this o?Il:ction of informal~,oo is zstimatrf .n yang ~, n-. z range cf IU hou*, a_s an
<br />accrage per response for some min.rr faalities, to 110 hours as an average pr r ra ~, ~ u.c for >:om~; ma;or fa.ihhes,
<br />with a weighted average for tnafor amd minor facilities of l8 hour:; par tea".n-~., w~9uding time for racicwing,
<br />instructions, searching existing date sources, gathering and mainctininp :h~: dr.r ^ecdrd, and xmpletiog ,md
<br />roviewing the collection of infornratiou. Send cutnmen[s regarding the hmdrn c<!umde or an~ other aspect or
<br />this collection of informauom, including suggestions for reducing [hiis budru io t'hirf, In`ortnation Policy
<br />Branch, PM-223, U.S. Environmental Protection P,gency, 401 M Street, SW W uhington, DC '10460; anJ to [he
<br />Office of Information and Regulatory Atfairs, Office of Managemzmt and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed a[ entry of that information
<br />already preprinted.
<br />2. Enter 'Permittee A'ame~"rblailing ilddress (and facility name location, if dilferenl)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each disch;trgc.)
<br />3. Enter dates beginning a»d ending ".ttoniroring Period" covered by Corm where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of pcrtnit.
<br />5. Enter "Sample 6leasure;ncnN' data for each parameter under "Quantity" ;md "! ~unLh" in traits specified in petnut.
<br />"Average" is normtdly ariJtmctic a.+:rage (geometric average for baclen;d parama tern) of ;dl sample measurements
<br />for each parameter obWmed donne "Slnniforing Period ; ",tlaxinrunr" aad "tlnnanun" ;ue normally extreme high
<br />and low measurements obtained during ",llnnitoring Period." (i~lo;e m n ~r:inpals with secondar: Irtaunem
<br />requirement: Enter 30d;ty avera6c of sample measurements under "Acereve," .wd ;inter minimum 7-,fay accrage
<br />of sample measurements oblainec d.tring monitoring period under ".l/m i~•m,n "i
<br />6. Enter "Permit ReguiremenP' for eaca parameter under "Quantity" and "~ 1uu~rry' us specified in permit.
<br />7. Under "No Ex" tinter number o.` sample mcasurmenls during monilotint~, pcnod ;nat exceed maxin;um (ard'or
<br />minimum or 7~ay average az appropriate) permit requirement for each puramclcr. It none. emcr "0".
<br />8. Enter "Frequency oJAra!ysis" both az "S'arnple Afeasvnnen!" (actual 'rc.lucnc} c` sa:npliog :md analyss 'r,cd
<br />during monitoring period) and as "Fermi! Requirement" specified in perniil (e.g. Enter "Conn" fu: continuous
<br />monitoring, "1/7" for out: day per week, "130" far one day per month, "+ 9t " fcr one day per quarter, c:°.1
<br />9. Enter '1Cample Tvpe" both az "Scruple ,Lleasuremenr" (actual sarnple tr[e used du::ag monitorng prod) and as
<br />"Pennil Requirement," {c.g., Enter "Grab" for individual sample, "~~ff.'t"' Cor ?=-hour campositc, ";i'A" for
<br />continuous mortiloring, e1c.)
<br />l0. Where violations of pemrit requirements are reported, attach a brief e~laarat:on to describe :ause aad correctn'e
<br />actions taken, and reference each ~ iolation by date.
<br />1 L [f "no Ischage" occurs during monitoring period, enter "No Discharge" :+cr.:ass form 'ut place o`' data u.tr}'.
<br />12. Enter "Name/I'i!le of Pnncipal Executive Dicer" with "Signature aj Pru. cipnl R:rc:~urivr• U>Tter ,a~:l uthor,:.v1
<br />Agent," "Telephone Number," and "Dale" al bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) sptxified in perntit. Retain copy Cor yn ar tee ord-a.
<br />14. More detailed ittstnrclions For use of this Discharge A-lomroring Report (I7.Lf.RI larni m.ry be obt.tined from O(Te_;s!
<br />specified in permit.
<br />Legal Notice
<br />ILis report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to rr~ort or failure [o n_port truthfully +an
<br />resuh in civil penalties not to exceed 510,000 prr day of violation; or in criminal pmalt;es no' to eacn:d $25.000 per da.
<br />of violation, or by imprisonment for no[ more than one year, or by both.
<br />EPA Form 3320.1 (Rev. OS-97
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