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I'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, 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 />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 "Permittee Name/Mailing Address (and facility name location, if different)," " Pzrmit NumF.zr," and "Gis::hargz
<br />Numtzr" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Porametzr" as specified i^ monitoring requvcmeots of permit.
<br />5. Enter "Sample Llzzsurzutzn!"data far each parameter under "Qrr]ntiry"and Quality'' as sp:;cificd in permit. 'Avzr,gz" +s
<br />normally critlrmeiic average (gcomeric average fur bacterial psran-~ctcn) of all sa ~,,:c measurements fnr each pr-r re~er
<br />obtained do ino ";•risni!oring ,°~rio.f"; 'S,;.ui,;m~n" and ,Ut;riruun" are .imma;ly extreme high and lo:v mcasuameuts
<br />obtained during ".~do~r%!oring Pers.{". Q~!ctc to municipcls wiih secondary Creatr:,nt n•ruiremen : '=ate- 3C-day avera;,~e
<br />of saartple measr.remeuis under 'f1v~, Boa,"and enter nia::imw~ 7-da; average of sample measurements ohta~ red du ing
<br />monitoring period under "ivlaxirrtrrr.")
<br />6. £• !e "Pe,-„ri! 2.}eiw_man" for each pa*am, icr under "Qu. v,!%.y"end "Quality" as r:p..,:i,i;,d in perm:.
<br />7. Jndcr':rJo ~Sx" ent : uwmber of eamp!c ~rczsu;cmc ~.t c;w'ng mcnitnriog peccd thz. c.crod mgr mum (and/or min'~7u.n
<br />or 7-day average as appropri ~) Fc.-~r,it requiremca for each pazmctcr. ;f none, en!,:r "0".
<br />8. ?ore:• "rrw•}t,,r_y cfA„11s,'s•' both ¢s "Sa,::}-k ,~~:~ ~sr•,~a;;t~.rt" ;e=tua! f~~qu_ccy o"..u npl'rg 2-d ~~2'~sis i~scd dor:„
<br />me:ctoriag pcrod) aid as "FC;,ni! 2 }u%reors,u" spcci "cd i. p=.mit. (c.g. =nttr "C;,u,"for ccctiruous rr.onitoring, "1/7"
<br />fo,- ane cay pe; c~ee'.c, "1/30"'fo: ox day per month, "1/90" for one day pei quarter, etc.)
<br />9. Em`e: "3arn}-!z TyFz"both as "S'„.plz iv;z~s2vvrn_;d" (ectua; ~,.mnla iypc used during monitoring period) anti as "Pe, ~n;r
<br />R_.}uirznrznt," (e.g. ~:ntcr "Cr.r" fcr inu:vid_~zl sample, "29NC" for 24-hour ~o,npusite, "iJ/fi" for coornuoas
<br />monitoring, etc.)
<br />10. ll'here violations of remit requirements zre reported, attach a brief er;pisnaticn to dsc-ib:, cause and eo,Tec~ivc ac:ic as
<br />to be ta'cen, and reference each violation by date.
<br />1 L If"no discharge" occurs during monitoring pcricd, enter "i~lo l;ischarge" across form ;n place of data entry.
<br />12. Enter 'NarnelTitlz ~f Principal Ex~cutivz G~._=r" with '$'ignafw•z of Frin,•iF ~l Erzcxtt5vz O~rczr of Aut;vrued
<br />Agznt, ""Telephone NumEzr,"and "Datz" at bottom of form.
<br />13. iviail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. Viore detailed instructions for use of this Dischurgz ,Ulmitoring Report (D~YIRJ form may be cbtained Gam OlTice(s)
<br />specified in permit.
<br />Legal 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 year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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