|
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, 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 partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Pernrittee NamelMoiling Address (and facility name/location, if different)," "Permit Number," and "Giscl:arge
<br />Number" where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "lvionitoring Period" covered by form where indicated.
<br />4. Enter each "Pormneter" as specified in monitoring requirements of permit.
<br />5. L-ntcr "S,naple irLJSVrernent"data for each parameter under "~c~ntity"and ~r:a!i!} " as specified in permit. 'n v_rage" is
<br />normally arithmetic al~erage (geometric overage for iracterial parameters) o: 211 sr~rp'.c measurements fo: each parameter
<br />obtained dw-ing "i~ioniioring,~a,•iod'; "i~9,zri;,nu:c" and ~biuri,;nrm" are aormally cx[rerte high and low measuicmurts
<br />outainc_t dung "!tz'o,ritsr%ng Pn•luf". (Vole to municipals !a~ith secondar/ .ma[m:,nt cquircment: F.ntcr 3C-day ave-ag.:
<br />of ;a- ale ,neaswemen[s under fv~rns ~,"cod enter maximum 7-day average of sccplc a!easme,rcats obtained du u~~
<br />monitoring period under "irfaximur.r.")
<br />5. Er..er "Fe,,ait R.r;ri~ anent" for each parameter uncle: "~ieentiry"and "Quo!%r, "rs spccifi~d in permit.
<br />7. Cndu "iJ•. Er" ea'sr n:rnl er of sample -casurcan: c'~iring _ncni[or.ne pe.-icd thr; _xcec3 saxtmum (.:ad/ar ~~u.i mum
<br />or 7-day avergc zs appropria'c) permit requirum.ot ;or each parmneter. Ii none, corer "0".
<br />3. :.r'e- "F,-s.ju_.c}~ o}'~I,~.rl;si!"bode as "S~rr~l~ basi~r~m~~u" (actual f-eq~eac, o"::anpliog and antlysis used dw~~; ~
<br />'mo.r'tonng period) and as "?e,~nir R~./n5-unent" spcciFed in permit. (eg. ante: "C~n!,"fog contnuous monitoring, "//7"
<br />far ore day per v.~ec'.c, "I/30"for one day per monu±, "1/90" for one day per quart=;, etc.)
<br />S. Fnf~: ".S n:y le T}E~"bo:h as "Sep:rFlr ivi_~ai~~-~~me,u" (actual ssmle t}'p~ used dura~y monitoring period) anfl as "Pe.;,,i!
<br />R_,/c•ira;rcat," (e.g. L-nter "G;~al•" for individual sample, "29HC" for 2S-hour composite, "iJ/A" ;or continuous
<br />monitoring, etc.)
<br />10. F:'hci e violations of permit requirements*c reporle~i, attach a brief ezplenalion to dcse,ibe cause and corrective act~arts
<br />to be :~ceu, and reference each vio(atiou by daft.
<br />1 I. If"ao discharge" occtrr=_ during monitoring period, enter "No Dischazge" across form in place of data entry.
<br />] 2. Winter "Nem/Titl~ of Principal Eszcutiva CiJJicer" with "S%gnahrre of Princip ~! Esecutive Officer of Authcri: ed
<br />Agent, ""Tzlephone Number, "and "Date" at bottom of form.
<br />13. r4aii signed 2:-port to Office(s) by dale(s) specified in permit. Retain copy for your records.
<br />14. lviore detaiLd instructions for use of this Dischargz Monitoring Report (DMl~ form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />Tlvs 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)
<br />
|