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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 />General ~~structions
<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 Arllrzss (and facility name location, if different)," " Pzrmit Number," and "Discharge
<br />Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing 'Sonitoring Pzrio ~" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sarnpl. ,LL•~surz,nz.n" data for each parameter under "Quantih,~"and ~itlalitj~" as specified ~n per-mii. 'Av;;r~se" is
<br />normally anGSmetic accmge (gaametrie average Tor bacterial pa~~meters) of all samt~le measwe n pots far each pt:z- eter
<br />obtained during 'S6;~.ailoring Period'; "le; tci,nurn" and itli.rimum" are no~taliy uxtrc: rte high and lo•.v meascrmen Ls
<br />obtained during ".'.•I~nilcri,:b Pars!". (?Cote a ratr-._c: gals vi~t secouday treatncrt : c +usement: Enter 30-day e~~c ago
<br />of sample mesurcrrents under "Av.raa ~,"and enter me:cimam 7-dsy ave:age o'sr-~ ,'c measurement; ob~incd duing
<br />maoitori ng period under '9Liaximum.")
<br />6. 'inter "Pa-,ni! Rgttir_mznt"for eac„ parar~cu_r under "~r.,rliq "a-!: "'%salir,~"as s; ~,i icd in penm~i.
<br />7. Jr.der'Sd~. L'.a" anb~.: numScr of samp!a n,,:r;uremrn+ ucrin~ n'ocrton~ig ,.cind tr~a+ ._.:,d mrx~mum (andl~r ~nie~~:nim
<br />or 7-day average as r-.proprate} ;,emit n:quismen*. fur each parameter. ' f none, ei!_r "C".
<br />8. o:c: "Fr.7.~eu_,• ~p`Analpsts" both as ".5.,.;f !_ -vlts", r,,.en!" (actual fieyuer.cy a~ sc-npling and cnt h~sis ;;sed c;ur ,~
<br />monitoring pccad) a ie as "R.-.-,.ti! R~ /trir-~r;,:,' "s,eci`ed in pc;~-mit. (c.g. Fntcr "..s.rr," ~a, coy inuous ronitoring, "I/7"
<br />fcr one day par wuelc, "1/30" for one day per month, '';:'90" for one coy per quarter, etc.}
<br />9. :.Hier "S.nnFL TyFe" ba:u as "SJnIFIG n.1_'S1!.'G.IICY^." (~ treat sample type used duri ,II monitoring ncrioi) any es " _, ,n l!
<br />R~yvir,~,ir.;r!," (eg. Eater "Grey" for indi~,idual ~cinplc, "2v'Jr~" fa 24-hcrr composite, ',a%A" for coo',uous
<br />monitoring, etc.)
<br />10. `,r/lrerc violations ofpctmit requir-maits arc rc;;orted, attach a brie: c;:planation to describe cauv and corxtive a~;in ~~,
<br />to be ta'.cen, and reference each violation by date.
<br />i ]. If "no discharge" occurs dt.rir~ mat,~toratg period, ewer "?do Biscitarge" across fn..n in place of data ent y.
<br />12. Enter "Name/Tille of Principal F.x•cztlirs G~~'r" with "Sibaraurr~ of Prin.:iPll Ezz.u[iv~ Deer of ft~+h ;,i;.~_!
<br />Agznt, ""Tzlaphon ~ Arunrb~r, "and "Date" at bottom of form.
<br />13. A4ai1 signed Report to Office(s) by date(s) specified in permit. Retain copy for your rcords.
<br />14. More detailed instructions for use of this Dis;;lrarg~ Monitoring RrFor! (Ci/IF2) fmm may be obtained from C(i<c-_{s)
<br />specified in permit.
<br />1[...egal 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 coo result i^
<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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