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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 />Generai InstrL!ctions
<br />If form has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Nome/Moi/ing AdJrass (and facility name location, if different);' "Permit Nwnber," and "Discharge
<br />Number" where indicated. (A separate form is required for each dischazge.}
<br />3. Enter dates beginning and editing "Monitoring Perio.I"covered by form where indicated.
<br />4. Erter eacl, "Paranr~~ter" as specified in monitoring requirements ofpernrit.
<br />5. Ente* "S_~mple +bfdasarenre,et"data for each parameter under "Quvrtil~~"and Quality" as specified in permit. 'Awr~~e" is
<br />normally arithmetic avu-ege (geometric average for bzcteri.l p;irmetu.•s) of all sami~le measur~mon"s for cacti per2Ztetcr
<br />obtained during "Iv%%,oi!oring Pzriod"; "d;'.~~:im±~,n" and ;~fi,~%„ufua" z-a noTna]ly c:arcme high ant; lo~.+ mcasl:r;menu
<br />obtained during ',Ac,rito;ing P~ri:J". (Note a mu- =ipzls o:iC, secondapr trcatr~_at requitement: Winter 30-dsy avc-age
<br />of szmp'e me=suremeats under Avr,-agr," wd toter m,.c i,eum 7-day ave; arc of saw ; Ic mecstcemcn's obta~~ned during
<br />moniroring period under "ivlaxinr:rm.")
<br />u. linter "P2nni! R2~Nf. drOL71"for each porn-c,etcr unc:er "Qrlnri p'"r.-:; "Qev1i•7+" za sprrifcd in pcrn: .
<br />7. Un!cr "iJ~, E.r" eater nunber ofsz r~ple mcaswrmen~ during uaia,i.i~,acd t`nl .csd mivcinwn (and/or min'mu•r
<br />c; 7-d y avcrzge as appropriate) j. c:~ii rcquirma~t for each pa.am~icr. ; f no::o, cater "0".
<br />8. EnSCr "Fr,:7~r~,r,.y ojArralpsis" both as "5~,.,r ~ %r; o• ~.,rr~,az,Tr" (acb-~zl f'cqu. cc~~ o~ scmpling and rn; lyss :used dur'ng
<br />meP4.un lg pfrAd) rS,.~ as "PdiiAl! Re;llii di)tJ:~r° SlCC4~!fL ~.1 pGT1'. (C.g. itniCr " .:,Ir," iUr CCi:i.nllDlls `.DnltOr:ng, "]/]„
<br />fcr one day par v: edc, "//30"for one clay per month, "t/90" for ore day per quarte-, crc.)
<br />9. 2ntcr "S.rrnp/,: Typz"both as "Sampla %V%rJSi~.'aad't" (cci'~al sample iypc LL~.Gd dun~1L mo.,iw ng ~erie:I) and as "!'s,}nir
<br />Ra;luire,nz.lt," (e.g. Enter "Grat" For individual sznple, "14h'G' for 24-Low composite, "iJ/A" for continuous
<br />monitoring, etc.)
<br />' 0. `?there violations of permit requirements arc re~oReil, attach z. b~eF e;cp:u:,:,in~ Ic d Bribe cause and corrective aciiors
<br />to he taken, and reference each violation by date.
<br />1 I. If "no discharge" occurs during monitoring perioc, en:cr "?Jo nitcl,ar~,^" rcross fo -.n 'n place of data entry.
<br />12. Enter "Name/Tit(a of Princif•a( F,x~.-utiv~ G~~_r" with "Sia~+uur.e of frin2i/~? Ezr_-utiva Og:rr of AuthorizzJ
<br />Agent, ""Telephonz Nmnber,"and "Dine" at bottom of form.
<br />13. i\Qail signed Report to Office(s) by date(s) speci5ed in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring R.~port (Dd91~ form may be obtained from Office(s)
<br />specified in permit.
<br />~.e~a~ N®~IlCe
<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 coo 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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