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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 I S hours per response, including time for
<br />reviewing instructions, seazching 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)," "Permit Number," and "Gischarga
<br />Numhzr' where indicated. (A sepazate form is required for each disehazge.)
<br />3. Enter dates beginning and editing "Monitoring Peril" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit
<br />5. Ente~ "Sanrp{e hSr~rsurenaa"data for tech pammcter under "LUamlity"and L3uafig~" as specified in permit. "Aver ~gz" is
<br />no,-ma'ly a-ithmetic ~: crag.: (gcnmctric average for bacterial parameters) cf a!] sample measurcr,.cnts :er each ~armeicr
<br />ob±ained during ",'.6~,lir%rimg : a~i;.~'; ",19:rirru,;r" and Afininrernl" are ro:-rna!l;• z~t~crne Ivgh and :ow measurrmcnts
<br />obtaircd during "~:1s:ul~,rine F.•Iia". (Note: to m1Ll'ci c]s vrith secondary hcatrnc~: requirement: Eder 30-day avc-a~c
<br />of sample muaswemc-ts under ".'v~;~ o. "and en:cr r^~cimum 7-dy average n; szt-.p!~ meas:uereats ouzired du.~co
<br />monitoring period under "tYlaxi;auai.")
<br />J. °~l,r "PCI'r:]It R2~nl(Lnie:71" fn-each parame~er w-t?cr °~if_iihh'" azd "~ifdhCrrr ~ ~.. L`CllICd m pertc't
<br />7. lindrr "N.c Fx" t-!'r_-m~mba-ofsa^*:!e mecsurcmen' during n-or;L^- %° rcrin2 t;+at c:c.ed m•ximu;n (;.rd/et:',in~:ru~,
<br />o; 7-dzy eve €c as apprcp~ate; pcmit r..qui;cment ;ur each parameter. '.fnone, cntc: "D".
<br />R. En'cr "Fl~egrtn_y ~j "fu{ycic" bu:a s "~_ -fz Li_~.crr:,,,"ir" (actual f:.quer.c° n` sampling and ane]ysis used luring
<br />monitoring period) aid as "P~;-a:i! ~~~-~lrird;~i ~,1!" srtci~iz:l in pe init. (e.g. Gotc~ ""%.1!," .or ccatinuous nonitorirg, "//7"
<br />for one day per v,ce!:, "{/30" fu; one ,ay per menlit, "I/9D" for one day per quarts., ere.)
<br />9. Ln a: "S~r,:p/~ T}F~"both es "S_~,77L• ~l.'_vclc ~~.u,~t" (sctual samplr. type used d~rng -nonito~-ng ncicd) aid as';°~;;a;r
<br />R; rirs:nr.tt,' c. d. Late, ~,a
<br />g ( - ""- t" fur :~di~•idual s^~rple, "?4I1~ ' for 2?-Coto compos:.e, ';`,%A" for cor!inucus
<br />monitoring, etc.)
<br />(0. `;~/h:rc violations of permit reduirerzents ar.: re;ored, attach a brie` e:;r',ana~ion to d~caibc cause and corrective actions
<br />to betaken, and reference each violation by date.
<br />' 1. If "no discharge" occurs during monito-ing period, enbr'TIo Discharge" across form in place of data entry.
<br />12. Enicr "NamelTit{~ of Frincirol l:::r;ar/ivs G~~_>-" with "Si„IUtf,.z of Fri,; ic1! Esacur%vz Officer of Au!holizzd
<br />Agzmt, ""Tziepkorr3 Number,"and "Date" at bottom of form.
<br />13. ;vfail signed Report to Offce(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of t`ris Dis,:harda Moni!oring R.apon (Cb1R) form may be obtaiocd from Office(s)
<br />specified in permit.
<br />~t~~2dl ~®tice
<br />This report is required by ]aw (33 U.S.C. 13 ] S; 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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