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Paperwork Reduction Act Notice
<br />Public reporting burden for this collecrion 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, Liformation 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 already
<br />preprinted.
<br />2. Enter "Pzrmittee Nrnne/Moifing Address (and facility nameflocation, if different)," "Permit Number," and "Gsschar3e
<br />Number" where indicated. (A sepazate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Monitoring Period"covered by forth where indicated.
<br />4. Eater eats "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample /vlaasu; drnent"data for each parameter under "~uanli!)%" and Quafitj,"as specified in permit. 'Aver .*ge" is
<br />normally aritlunctic a~:.mge (geometric average for bac.erial pamm: crs) of al] sam};le ncasurcments for each par~metar
<br />obtained during ";v;;,ritori,ro Pcri~d'; ",14„.amn=a" znd ,fi%timunr" arc normally e.:r c,nc high and lc~.v measurmeats
<br />obtained during "J.fonit~rinb P„ri ,J". (Note to mun+cipals c;~tl-~ secondarl• trta'meat rcquL-cmcnt: Enter 30-day uve-rgc
<br />of sample measurements under ';ivsra~~."and enter cucimum 7-Coy average Ji sanp'e mcasw..~~ ants aStained during
<br />monitoring period under "fvfacimum.")
<br />5. Enter 'Pe;nit ,7.~gui;-e,ne;rt" for each parameic; under "qua;city"and "Qrrafit)," as s ccified in permit.
<br />7. Under "P!=. E.r" e~tcr number of sample measuremnt during monitn~ng trot that cxc~rd maxi°um ;and/or min 7~! n
<br />or 7-day ave ~gc as appropriate) p„r,-ail requ~rcmea for each parmeter. If noue, talc.- "0".
<br />8. En'.er "Frzgran~~ cf An_rlysic" hots as "S-~,~r,-L ;.4r~s~:re,:rrnt" (act_al f.-..quency n` sampling anti analysis used Ci 'ng
<br />monitoring per.od) anC as "Fa~,ait Re7uir2.rvtat" specifcd in pOimit. (a.g. Enter "^=,,,r,".or cor.t:nuoaG ~oaitorirg, "1/7"
<br />for one day per weely "1/30" for one day per month, '7/90" for one day per quarter, etc.)
<br />9. Enter "San/da TjT ~"both as "SamFfr ,1,'s.~sv. •e%a'n%" (a_taal samnL^ type r.rsed during monitoring perio; rnd as ","2r;,r%t
<br />R_gerirsr:rzrr," (c.g. Enter "GraF" for individual simple, "14I;~" for 24-hour composite, "Rr/A" for ccr,tinuous
<br />monitoring, etc.)
<br />]0. Where violations ofpcrmit requirements ere re~crted, attach a brief explanation to describe cause and corrective actions
<br />to be taken, and reference each violation by date.
<br />11. If"no discharge" occurs during monitoring period, cuter "No Discharge" across form in place of data entry.
<br />12. Enter "Nam~Titlc of Principal Exactrtivz Gffi„ar" with "Si~rratu.e of Prin::ira! Frr:CtltiVe O~crr of riu[horiud
<br />kgent, ""Telephone Nu,nbar, "and "Gate" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your rcords.
<br />14. More detailed instructions for use of this Gischarga Moni[orir[g Raport (GMR) form may be obtained from Office(s)
<br />specifed in permit.
<br />~,egal 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 to 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 yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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