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Paperwork Deduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of IO hoots 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. i
<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 "Pe+~ni!te~ Nome/Mailing Address (and facility name/location, if differed[);' "Permit Number," and "Discharge
<br />Number" where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "Aonitoring Period" covered by form where indicated.
<br />4. Enter eacb Paramd!_r" as specified in monitoring requirements ofpermit.
<br />5. T rater "Sarrfle bL~sura;narr!" data for each parameter under "Qer.xnriry" and Q~uliry" as specified in permit. 'Aver~oa"is
<br />nomally arithmetic avtrage (geometric average for bacterial pammetcrs) of all sample mcasu~ements i0r each prr -ne cr
<br />obtained du:in~ "m;sniroring Period"; ",lU.reuun" and ,Yli;;i;eul;l" arc normally c:attane high and low measu,;racnL,
<br />OJt2med tiW'7n}~ '~~/~~.1!IOr711b' P~lIO.~". (jtniC IV muni:iprls ts•i[h sccond;.ry sral*c=rat r~•nuiremcnt: inter 30-day 2`1C:3ge
<br />Of .i~~7171.^, tr_aau:emcnu under "Av_r,to ',"and Ceter ma'~:'m~il 7-day aYCrage Uf SZi~!I71.", me1JU7Cm_:lib Obta:-tcd dL "lll!;
<br />monitoring perod under ".Yiaximurr.")
<br />G. _^~ "P~•;~;ri/R;rt~ane~a"Core.chparamtirrunctcr"Qran!ii;~"2nd"ywalih,,"assiccifedinl-crs-r:.
<br />7. Und~_r ":Y, rir" ., ...- ucrnber oframpte ~n_ts. rc.:cnt du~iag nonitonu~ pc~ud ti~_f cx^_ct3 naximwn (and/or ,:ir,~mu n
<br />or 7--day a : cr~gc c~ arpropriace) permit requireme~.t for each parameter. ifnone, cntat "0".
<br />13. time "F',~;,,_;~~~ ~fA,r~l~o s" both &.^~ "S.m;-I~ ;vi__~s•~'srue,;l" (e;htal f~qu_.:cy :,r s2mpling rag <ia'., ,is used din iu,",
<br />rnauitoring per ed) anu as "Pa-„»1 R.,,lrir~-;ren!" spec!fied in p=rmit. (e.g. Fn.e~~ "G .r',"fur contmqus monitori,l~, "!/7"
<br />u:r cnc dry per vJCek, "1/30" .or one day per month, "1/90" for ore day per quarte,-, etc.)
<br />S. 3a.e~ "Sarg,le TyF ~., both as "S_mTlz 1,_as u, zm a.!" (actual samnlt iypa used _.ucng monitorog Acriod) and as 'PI,-rli~
<br />R~rrirv„t~,t!," (r..b. Enter "Gruff-" for ~ldiv~dual sample, "24ff~" for 24--ilow composite, "iUA" for conr'. uous
<br />monitoring, etc.)
<br />;0. !'.J)tett vioiahuns ofpclmit requirements ere npoRCd, a[[aclt a brie: c;gtl>naticn to eescribe cause and corec~ivc acrd Ls
<br />to be Laken, and reference each violation by date.
<br />1 1. I~ "~~ discharge" occurs d.iring monitoring period, enter "Nu Discharge" across form ir. place of data entry.
<br />12. ante: "Nal;te/Ti!la of FrinciFal Fs t7rtiva ~~.r" with "Sienatura of F'rurci/:~l E.rec±ttiv_ Gear of Aut;rcri:ad
<br />Aben!. ""Te[aEhona ,Vul;rbar,"and "Dare" at bottom of form.
<br />3.:.:ail signed Report to Ofice(s) by date(s) specified in permit. Retain copy for your records.
<br />' 4.::Iore dctailad instnlctions for use of this Discfrargz Monitoring Report (DrYf/j! form may be obtained Gom Office(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 mote than one year, or both.
<br />EPA Form 3320-1 (Rev. 03/99)
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