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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 1 S 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. Envtronntental 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 "Permittea Nume/Moiling Address (and facility nameAocation, if different)," "Permit Number," and "Gischarge
<br />Number" where indicated. (A sepazate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Puramztsr" as specified in monitoring requirements of permit.
<br />5. Enter "Sa+nple Measvrzm~nt"data for each parameter under "Qulntitl~" and Quolifj•" as specified in permit. "Averase" is
<br />nclmally al'thmetic average (geometric average for bacterial para~nete~s) ofall sample measurements for each pt~anetc
<br />obtained during ",bio~ut.ring Period"; ",'vf_~<iuu%m" and hliniuuun" a*e nominally e:acne high and loh~ measuremenis
<br />,,, ,,
<br />outzmed urulg n•, ,,11to,iag Pe:ind". (Nate to ma:.ic;pals with sccondaq' treatmcrt r~tuirement: Enter - °, ave.~ge
<br />of sample measuremenia andcr'itvaruge,"and enter maxirnum 7-d:y avsge of sr:~,-.!c mccsuremcnLS obLainad durirg
<br />monitoring period under "iviaximum.")
<br />6. Enter "Permit Rell•%. ~+aenr" for each pazame:er under " ;'+•~mih," ar,c ",''a•oliry" as specifird in perk"..
<br />7. Under "~d~ 5.r" en:cr number of srm; le m:asw-emer+ during Inonito,in~ ; grad t. nt :.csd ma ;imun (aad'nr ri.~-,~n-1
<br />or 7-:.; average as a; propriate) ;omit req,rtr~ nc~~t for each parameter. If none, enter "0".
<br />6. EnLr "Fr~y~r2ncy ofRnuhu~r"both rs "S.~, ---L .V,~ +s~n~_,;:~+rt" (actual L-equercy c's~ mpling and any lysis ~sed dw lg
<br />mDnlinrn~ perod) 31;1 as "Pd in'I ~~ :)Pi!'4iL'.i+" sceral led in nc:mit. (e.g. Enter "~•,,,r," for contnuous :nonitorulp„ "1 /7"
<br />fls one day per week, "1/30" for one day per month, "t/90" for one day per quarter, etc.)
<br />S. L•ntcr "Sa,;+~-!a T}Fa"botii rs "S~.nrL ;~:zo~;~rs;;+~;;r" (z~tual ;,ample typo used dung r,onito:=.r3 pciod) ar:: a " _,„+it
<br />Reyuirarae,r!," (e.g. Enter "Gral•" for iudi~id4al sample, "24H~" for 24-hour composite, "i~'/A" Ccr coy'-~:aus
<br />monitoring, etc.)
<br />10. PPacre violations of permit requiremcns ^re reported, attach abrief e::planatio-l *.o de;~ribc cause and curr;;c;i~;c cG'~ns
<br />to be taken, and reference each violation by date.
<br />1 1. If "no discharge" occurs d~rino, mc:.;tDring period, en:er'P:o Discharge" across form in plcce of data entry.
<br />12. Enter "Name/Tit(e of PrinciFal F.xr.:utiw_ G~c_•r" with "Sianahve of Pn%n~iJ' ~! Ers+tivs rJ~~_•r of .'n!Ss,~'-= t
<br />Agent, ""Telephone Namnbe;;"and "Gate" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specif ed in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Gischarge iNonitorinb Report (GA•.7~ form may be obtained fmin Cis cc;~)
<br />specified in permit.
<br />~.e~al 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 no[ mom than one yeaz, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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