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- -- -Paperwork ReductHon A.ct :'OToti;c~ - - --'
<br />it Public reporting burden for [his colle<iiun of information is rstimz,tul to vary hum a ra-tge of 10 hours as as
<br />average per response for some minor furi!ities, to 110 hours s. ur ave.-::~~ _ ~~r • a"•. f:;. ;,,m~ rm;or faciiitie.,
<br />', with s weighted average fo:~ melon end minor facilities of ~,E hours p..: .,.;;F,:n:_, ~,n..u.:i.~g :;ne for n:~~icw,n_;
<br />', instructions, sc;arching existing data :ounces, gathering and .~aintair~ ;~ :',, ... ~..:m.•d:J arrd complehmg snd
<br />reviewing the collection of mfortnahon. Semd comments regaling the ,~.,r. w ~ .,~m;de ur ur}' aha aspect of
<br />' this collection of infot,Datiom, including suggestions for reducing thi. ~~., k;, to ~hicf, L•dormanon Polacy
<br />Branch, PM-223, U.S. EnvironmenW F'rotec[ion Agemcy, 401 M Street, e'p~~ R':.rhingtun, DC 20460; and to the
<br />'~ Office of Infortna[ion and Rugula[ory Affairs, Office of Management and ~:,J;et, Wyshington, DC 20503.
<br />General Instructions
<br />t. if form has heed partially completed by preprinting, disregard ins-trvctions d~,re_ted of entn• of that information
<br />already preprinted.
<br />2. Enter 'Permi[tee Name,:4failing .4ddress (and facility name/loca,tiat, it dilTercnQ," "Permit Number," and
<br />"Discharge Number" where indicated (A separate form is rtxluired for _tch discharge.)
<br />3. Enter dates beginning az~c ending 'alnnrtoring Period"covered by fornt ,lyre indicated.
<br />4. Enter each "Parameter" a; specif cd .a monitoring requirements of pen:....
<br />5. Enter "Sample Afeasurem nt" d:a:; :u: wch parameter under "Ouc r., r.
<br />".tverage" is normally a~iSmc.ie avurage (geometric average for b::c.~a
<br />Cor each parameter obtmr a; during "Sfunaoring Period"; ".ifarin c:r"
<br />and law measurements obt:-intt. curing ".lfonrtorinR Perwcl " ('~o;
<br />requirement: Enter 30-d:.y avcragr. of sample masurcments under ".I
<br />of sample measurements ootaiacd du: mg monitoring period imdcr ".41ax
<br />..ad ":.unhh" ~ unit, spa:ificd is pcrntit.
<br />~2rmuacr.) .r,~ all sautpl.: measurcrnen,:
<br />ud ".t4n:rn:nn" ;. re normally errcntc tigh
<br />t: nni r.r.:ip-1s sat: ,ccoadan trcalmc;a
<br />•o,{~•,' a.•~d cnt.. maximum '~iay sverayc
<br />ururrr ",
<br />6. Enter "Penni[Requ,'renu•r r" for each parameter under "Qum;tiN" and "Ounli(r%' ;ts s~xc:fiea in ixrnul.
<br />7. Under "No Fx" enter number of srmplc measurments during monitcr.ag petrol that axcec! ataximum iand;'er
<br />minimum or 7~ay average as appropriate) permit requirement for u"rch n.:ramacr. If none, enta: "r)".
<br />8. Enter "Frequency ojrinalvsis" lath as "Sample .tleasurment" (aced ~re~ucn~• of svnplin~ :.rid analysis used
<br />during monitoritg per:ai} and as 'f'~ r;.,lt .Requirement" specified in } ~. no;. ',e g., rimer "t'nni," for continuous
<br />monitoring, "1/7" for one day per •.~ rek, "1/30" for one day per mocth, " ~G' fcr one day lxr quarter, etc.)
<br />9. Enter "Sample Tvpe" hart. as "Sample ,tleasuremenP' (actual sample c.;x used d~arir.g monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "'~fil"' for 24-hour composite, 'S1" 4" for
<br />continuous monitoring, etc.)
<br />I0. Where violations of permit requirements are reported, anach a brief c~.planahon to describe ,mouse and corrective
<br />actions taken, and reference each tiiolation by date.
<br />11. U "no discharge" occurs during morai[oring period, enter "No Discharge" :;cross form in place o: data entry
<br />12. Enter "Name/title ojPrmcipa! F~ecutive Officer" with "Signature ojf'rurcipal 5'recutive (%~cer aj.4urhonzed
<br />Agent "'Telephone Number," and "Dote" al bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in petntit. Retain copy for your records.
<br />t4. More detailed instructions 1'or use of this Discharge rLlonitoring Report /U.1D2/ farm may be obtained from Offce(s)
<br />speed in permit.
<br />Legal Notice
<br />Ibis report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties no[ to exceed S1C,000 per day of violation; or in criminal p.:naaier~ not W exce.~ 525,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320.1 (Rev. OFr95)
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