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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 hottrs 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, Lformation Policy Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S.W.
<br />Washington, DC 20460; and to the Cffice 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, disregazd instruction directed at entry of that information already
<br />preprinted.
<br />2. Enter "Permitlee NarnalMoi/ing Address (and facility name.'location, if different)," "Permit Number," and "Discharge
<br />Number" where indicated. (A separate forth is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Pariod"covered by forth where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. inter "Sample Akasurament"data for each parameter under "~nantity"and Lualit)~" as specified in permit. "Avn•aba" +s
<br />normally arithmetic average (geometric average for bacterial parmcters) of ail sample ~iteasweraents for each parnetcr
<br />obtained during "d/~„r:!;ring Pzricd'; ".+v~ "imam" znd d.l:ninnrm" a;~ normally c:;trr uc hi~Jt and low measurcmcats
<br />obtained dining "P.f,ui!~.ring Pari~d". (\ote to munici;:als r;i'h secerdary treatment r ~ ;uircment: Enter 3C-day we ~~:
<br />ofszmple mcasurem:;- is under '~1v~,-~;~,"avd cater r-..zx±num 7-ds!~ average ofsc~~~; ]e me.~surcm°iis obla~ncd dur'rg
<br />monitoring period under "Maximum.")
<br />u. £vtnr"P~;zritl7a3uirane.r!"foreacbparameterunder"iuantit}"and"~u~litj,"assnccifiedivperutit.
<br />7. UndcY "N.o Ec" enter number of samnlc rrasuremctt during mon'a-ing n.rod t'•at c:;ceed m ;.:imam (and/or minima ~~
<br />cr 7-day aver, fie as a ;propriate) permit requircmccf for each parameter. If none, enter "0".
<br />4. Lnter "Fray.r~n~y rf ~Lu/ysis" both as "Sr.,~, !a :~l.an:; =;,; ~nr" (actual frcqucrcy n` srmplinE end anclysis used d•,dng
<br />monibring per,'od) and as "Per ;.; it Ragrir_•u:.at"specified in permit. (e.g. Enter 'Cost,"for continuous .~onitorin„ "t/7"
<br />fo- one day per wcc'.:, "1/30" for one day per month, "//90"for one day per quarter, cic.)
<br />9. ::rater "Sarrrple Typz"both es "Sa.n~L Ac'_t~su.-aru.n" (actual sample type used during ncnitoring period) and as 'Tar ;e%t
<br />R.:quiramz::{" (c.g. Enter "G;ab" for individual sample, "24HC" for 24-hou, composite, "1`'/A" far coa'~rucus
<br />monitoring, etc.)
<br />I0. V/hcre violations of permit requirements arc reported, attach a brief e;:planation to describe cause and corrective actions
<br />to be taken, and reference each violation by date.
<br />1 ]. If "no discharge" occurs during monitoring period, enter "A'o Discharge" across fom in place of data entry.
<br />]2. Enter "Namel'1'itle of Pr7ncipal E.r:crrtiv~ Of~_'ar" with "Signature of Prin:iral E.racativa Officer of Aa!ho;izad
<br />Agent, ""Telephone Number, "and "Data" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of Ltis Dis_barge Monitoring Report (Ch7~ form may be obtained from Office{s)
<br />specified in permit.
<br />~.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 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 year, or both.
<br />EPA Form 3320-1 (Rw. 03/99)
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