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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 ] 10 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 farm has been partially completed by preprinting, disregard instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permi[tee Name/IvJai(ing Ada'ress (aad facility name/location, if different);' " Pzrmi[ N•!mt`er," and "Discharge
<br />Numher" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Mo;ritoring Period" coveted by form where indicated.
<br />4. Enter each "Par-o:~rstzr" as specified in monitoring requirements of permit.
<br />5. Ente; SanrpL Marnrar:ant"data fer each parameter under "L«~nrit;~" aid Quin%ry" as specified in permit. ri ve;•to ~"is
<br />no„nz]ly ariGrrtetie c rerage (geometric average for bacteria] p;ramcle~s) of all sarnple ~neasure-ncni.; for cash pea ncler
<br />obtained dung ",L,'%,~%'~.ring P~'ri;l'; ':b;a::irarrm" rnd ,ainvaru;r" ae no:Tna'ly e:b::*ic high snd low measur~m._nts
<br />obtained during "..,.aitr.;i.rb Par-i;l". (Note ro m,L:;cinals v!ith :.econda., trca:m,n? r.:euirctacat: Entu 3C-day average
<br />of sample measurements under "Avaruga," and eo:er aaximum 7-cLy averaga n. ,.:.,;.': measwemc: Ls obtained dung
<br />monitoring period under "ivlaximm;r.")
<br />u. atcr "Prnrri[ Rr./rri. ~a.~uat"'or each par<rnetcr uili'a- "Y; i!s4L'ly" ~aCi "~r!gtJO'" a5 5~'iCa ied iG (c-Si IBC
<br />7. Under "TJ~, r:' enter number of sample measurcmcn+ dining ,~ on~luring : r;nc; t a' :.c_.d m:.~mu;n (cnd/or min ~ir~
<br />e- 7-dzy a~~c~~ge as r_,propriate) pcrnit requ~rernrnt for each pa~~rnctc,'. if none, cater "0"
<br />8. °r:cr "Fr,: ~:'arr y ~f:lr ~/yst," i:oth as ',^~,.•E !a %r :'_~.u•rr.,.C,r!" (actual f-aquc.•cy a":mn ,li-~ and cna'•; sis 'srd Lur ng
<br />:eonilorin~~ par'od) a•id as" _:.d%~ R.;!r6,'nr~at"s; cc;~icd in pernil. (cg. Enter ".. ,,.! •"~or conCm~ous -oailo.~ng, "1/7"
<br />f~: one day p_r c; ce:c, "1/30" for onr, day per month, "1/90" for one day ncr quaY_-, etc.)
<br />9. "lo'~e* ".S]G'f !. T)'/"" bDiit Er ".S!~ilf. ~1 IFi1.o b.'G.l 'i:f" (FCtual JamplC (n1C LSed (.uiil~ ~ Gni'c.-.Ili na ~o~) anL Cs ". _,~,n ;;
<br />Re.teircrna,z," (cl;. °_ntcr ":,;-,.P" for individual salmpie, "Z?//~" for 24 ~•oa: ecmpoaite, "A'/k" far co^! ~uous
<br />monitoring, etc.)
<br />l0. ~?.Riere violations of peT*nit requirmcnts rrc reparted, attsch 4 hief e,cplan•_~io^ .o de>c~ L-e cr use 2nd corrxtivc ac•.ions
<br />to be lateen, and reference each violation by date.
<br />i 1. If "no discharge" occurs during meuito~.ng pcricL, e.,ler "T.o Dischar~,e" acress fum in ilace n`d2;a entry.
<br />12. Enter "Narra/TitL ,j Pri,rrif.rl F.xz~utiva Gffi~_>r" with "Sievr~tu•'a of /'rin:%; ~! ..,a~atir•.: ~J~~~~r of f:u~';:•i-cl
<br />Agent, ""Taleplrone ilrumber,"and "Data" at bottom of form.
<br />13. 14ai1 signed Repot. to Office(s) by date(s) specified in permit. Retain copy for year records.
<br />14. More detailed instructions for use of this Disch~rga .tloniroring Rep;r! (C,YfF~ funs may be obtained from C,ncc(s)
<br />specified in permit.
<br />~.e~al 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 yeaz, or bolt[.
<br />EPA Form 3320-1 (Rev. 03/99)
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