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~'a~erwork 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, seazching 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 partizlly completed by preprinting, disregard instruction duected at entry of that information aUeady
<br />Preprinted.
<br />2. Enter "Fer-mittee Narne/Moiling Addrass (and facility name/location, if different)," "Permit Number," and "Disclrurge
<br />Nnrnher" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Parini"covered by form where indicated.
<br />4. Enterca:,h "PalJmeter"as specified in monitoring requirements ofpermit.
<br />5. F,nter 'Sampla rb1_asurenra,ri"data for each parzmc[er under "~iuarrrity"and Qrr_~lir)~"us specified in permit. 'itvrr4gz"is
<br />¢ormally arithmetic a, crape (geometric zveragc fnr bacterial pa-rmciers) of all sample measw-e:ncnis far each pz~a~eter
<br />obtained during "ttil.,:4oring Aariod'; ",1~I: :;innmr" a,id rV.inirann" are na ma'lt' e:arcme high and law measurcmcnLs
<br />obtained during ",'.-forutorind P~ri;w~". (i\otc to mulicipals wig seconc;ary treament re_tuirem::,.t: Enter 30-day average
<br />oC se.nple meuureme .'s under 'Avara,;_ rnd cde= -nzximum 7-day averapc of a~rn; to mcrsuremcnt=. obtained da~ng
<br />monitoring period under "I~laximum.")
<br />6. F.nicr"Pry;~itRequi+e~ne~+r"foreacbpzramcterun':-:"~ic.~rih,"an;;",'_•trality"assn-cifiedin,crnit,
<br />7. Under "P,r~, ~.~" c,'~r numbur of sample mcrsurcmcnt during .no ~t::rino ,~_~inL t' a[ r..cecd m ~yimum ([nd/rr mia;mn
<br />o; 7-day ave~~ge as zp; ropriate) ; ermit requir. merit for eac;t parameter. ;,' none, entc: "0".
<br />8. :.n°~r "Frrlnen_y %f.^.na(psis" both as "S_,n; !~ ;,;t~.cnr_,aa~ii" (ect;al @equerty n° sampling rnd cn~l~sis .used durng
<br />monitnring per'ad) a.-~_ as ';"e~~,ri! R~_i!rrrzrr;u. ~"sceciSed in pe~7a r. (ag. Cnier ",.•,~r!,"for cant~nuous ^~oaito~ir,g, "1/7"
<br />f..: one day per week, "1/30" for one day per month, "I/9(1"for one day per quzrter, cic.)
<br />4. inter "S_~rrpL T}Fa" 3otS as "Sarnpl~ ioirusn.~~:;:_~ ~"('.Cr_al sample t;~x used dmiug monitoring percd) rnc: as "F~n;tit
<br />Requirzrnzar," (e.g. Enter "Groh" for indwidual e[mplc, "24HC' fur 24houc ecmposite, 'SV/i1" for con!immus
<br />monitoring, etc.)
<br />:0. V/here violations of permit requirements are repcrted, attach a brief e.epla,ratioa to dzscribe cause anti corrective ;.et~o.ls
<br />to be taken, and reference each violation by date.
<br />11. [f "no discharge" occurs during monitoring period, cater "*:o Dischage" acruss fom in place of data entry.
<br />12. Enter "Name/!'i!!e of Fl~incilal F,xzcuriv~ G~•~r" with "Srbara!et~•~ of Prirzi/al Fz~aAiva O~~ar of Atulr,;~iz~d
<br />Agent, ""Talephare Number,"and "Dale" at bottom of form.
<br />13. \flail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Disc{iarde ~L1,nitoring Rep~rr (L'A41i) form may be obtained from Cfice(s)
<br />specified in permit.
<br />I..E~al N®~CIlCe
<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 tesutt 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 year, or both.
<br />EPA Form 3320.] (Rev. 03N9)
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