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Paperwork Reduction Act Notice
<br />Public reporting burden for this col]ection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minoc 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, 40l 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 />~e~teral ]instructions
<br />1. If form has been partially completed by preprinting, disregard instruction drrected at entry of that information already
<br />preprinted.
<br />2. Enter "Permittee Name/iYloiling Addrass (and facility name location, if differcot);' " Parmit Numbsr;' and "Discharge
<br />NumEer" where indicated. (A separate form is required for each dischazge.)
<br />3. Enter dates beginning and editing "M~nitcring Period" covered by form where indicated.
<br />4. Enter each "Farmneler" as specified in monitoring requirements of permit.
<br />5. :.nter "Sm-a; k d/s,tslu•a.-.neat" data for each parameter order "~rl:airy" and [Je•u!i!;~" as specified in permit. "Avis _~ge" is
<br />normally aritlunetic a~~crage (geometric avc:agu fur bacterial paran•zlers) of aIl samJie measure-ncn's for each par_ ndcr
<br />obtained d¢irg "~bhniMring Pzri.,i"; "i,Lu4;rroa" ar.d lvii;u,,::mr" are normall; eatrcne hiSF any law meascr_mer.u
<br />6JtainC'I :Il:ring ';1::...'rOring P!, S_~°. (NntC LO mllP,leiy7ais t;~i [i] SCCO Li1.'ry 7cah71 ~. ilt it ;uirdmGn t: Fntcf 30-dEy dvC ragC
<br />of sar.~ple measr::ements undo; "Avenb_," -gin:1 cat:;r m. ~:imum 7-day avzmge of sample mcsuremants obiaincd doing
<br />monitoring period under "ivhaximum.")
<br />G. E~.C~ "rN1111! 16:;P7]','672Hr" f0i C2Ch I:erd~TC:crL~SIGCi "~~:.ii.'+/,'" r~'d °in'~llly"w5 Spi:el~cd in pCr,ii.
<br />7. under "iJr, s" c~ ~: nt!-aber of sample n.~zs .rcrrc.ti dung •neniic,inn :cried [br.t ~e:ed maximur,. (cnd/or nir'•-iuc1
<br />or 7-clay s;erage as ~ lpropriate) ; e,art reeuiremc:.f . or each parameter. li none, en ^_r "0".
<br />8. ~c'cr "Frr./u_•a_~ rj An~l~s~s" L•ot't as "Ssr,-~-ls :.L.;a,~r~~~l_,u" (&~tual ~=cyu=•c, of s_mpling anQ anu(,sis used d~~ gin;;
<br />.aonitori ng per:ud) and as "'dn,li! Fe_.Iu~; r.:le,r: " spec ifi,d is pcr.r 1. (e.~. Sntc ; "Corr', " Con conCnuoas ncnitoring, "in"
<br />for one day per v.~celc, "1/30" for one clay per mo;tit, "1/90" for one clay per quzricr, etc.)
<br />S. °nicr "Sar.:t•!e TyE,:"both as "Sa.;rF1e .:7. ~sr -oa_w"(actual sampL typ=used dur:og Wvni:oring period) and as ", -nui!
<br />IL:ycirame.v," (e.g. E:+ter "Grab" for individ.~si sample, "24N~" for 24-i~ocr composite, '7Lr/A" for conlim~atu
<br />monitoring, etc.)
<br />] 0. \'~7here vioiations of Hermit reyuircments are reported, attach a b,ef ezplanati; u .o dese~be c: Lse and con-ec~vc ac[ioac
<br />to be ia'.<en, and reference each violation by date.
<br />11. If "nv discharge" occurs d::ring monitoring ;~eried, rnicr "No Discharge" across fo~?rl in place of data entry.
<br />12. 5nter "Nome/Titla of Principal Ex~cutiw_ Offi;zr" with "Signature of Pru1.;iF11 F_'.rec-7d,'v° G~czr of Aur;w,~%asd
<br />Agenr, ""Telaphcna NumE~er,"and '7Jate"af bottom of form.
<br />13. IL4ail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. Miore detailed instructions for use of this Discharge Ma7itoring Ripon (D,b.7~ form may be obtained from Office(s)
<br />specified in permit.
<br />~.egal N®tlce
<br />Phis 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)
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