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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 18 hours per response, including time for
<br />reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
<br />completing and reviewing the collection of information, including suggestion for reducing this burden, to
<br />Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Office of Information and Regulatory Affairs, Office of Management and
<br />Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instruction directed at entry of that information akeady
<br />preprinted.
<br />2. Enter "Pel-mittee Name/Mailing Address (and facility name location, if different)," "Permit Number;' and "Gischarge
<br />Number' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "tYl,nitoring Period" covered by form where indicated.
<br />4. Enter each "Pal'atndlLY" as specked in monitoring requirements of permit.
<br />5. Enter'S1mEle,i(~JSU!znznt"dataforeachparame*.erunder"[iuarrrity"ardQtra/i/)~"as,pccifier;inpermit. 'ilvdr~oe"is
<br />normally arithmetic uccrtge (gcome'vic average for bacterial p ;rameters) of all sample measurcncnis for each prlr rdcr
<br />obtaineu duri>ig ",LL-.Jtoring Period"; "ivla:i,;uun" and Liirir.rmn" arc nnTna ly r.;:;rcmc high anti tow measurment,
<br />obtained during "7.'-.rriforing Period". (Note to mw.icipals ~•. ith secondary trca.~zcn[ rcauirement: Winter 30-d<y s~~era~e
<br />of ser„plc measurerre-.s under "Aw_r,zot,"and enter rna,;imurn 7-day average of ;cc. u mc~~u cmens obtained c's;ng
<br />monitoring period under "ivlsximum.")
<br />U. $ICCi 'i~~.T.rl! R.dyn!/S1ddAt"for each parameter un_.. 'rihl:dt!(I)~" a9:: "~it!?lilt"as Si.JCi 'cd In ;7erm+:.
<br />7. Un!cr "Ah ^x" entur ,.umber of sample maa;uremcnt durng :non~tc,-s, ~crinit _t .:cctd oiarimmn (rnd/or ~~ir~ru~1
<br />c. 7-;icy wergz as sppropria[e) pe ~~ it n;quuene;rt fur each p~ameter. ;f none, en(cr "C".
<br />B. Entcc "Frs/r~a.r~~ ,jam n~lysis"both zs "S_.,,.-tz rvi~/vn'e.:%~,~t" (zctual frrquc-c, n' ,a n ,ling and unc'ysis ~scd durng
<br />monitoring t7CI!Od) ^_r;; a5 "rd iillr rt~'~i!If l"J~i19it"SGeCliled m pcTn'~. (C.g. '" ICCi r'('.u! ° i0Y CU: i~nL1Ci SG TOilaprl l~, °//~"
<br />fc~ one dzy per wcc:c, "1/30" for one day per monilt, "li90"for one day per quarter, cc ;
<br />9. Ln;cr "S.!mF?_ Tjy r"both rs "S.t~nrd~ bleusr :•~s;_,,t" (cchal sample lyp: u,ed durinli n on~to=rg n: ~uC) ant: as "P_,,,ri!
<br />2yeirarur.u," (cg. -ntcr "Groh" for individual sa~rplc, "341~C" for 2~-tine.; co.npcsiic, "i•.%f;" nor con!iruous
<br />monitoring, etc.)
<br />'0. Where violations of permit requiremerts are r.ported, attach a br,'efezp!m~arir.~ t^ d_s~`iL-~ case and co.~cclive actions
<br />to be take, and reference each violation by date.
<br />1 I. If "no discharge" occurs doing menitoring period, en:cr'Tto Cischarge" across urn in nlcce o. rate cnLy.
<br />12. Enter "Natn2/Titl~• cf A~incipul F,x~crrtiv: G/j~retr" ~.vith 'SSibnrattr,z of Po-irr;r-,t l:'s_urtir- i~_•~r of Aut;lsriz _a
<br />Agent, ""Talephens Nnmbzr•, "and "Dale"at bottom of forth.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your rocoids.
<br />14. More detailed instructions for use of this Dischordz tYlati[oring Report (Divi7tJ form may he obtained from Ctiic_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 or failure to report truthfully can result in
<br />civil penalties not [o exceed $10,000 per day of violation; or in criminal penalties not to exceed $25,000 per day of violation,
<br />or by imprisonment for not more than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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