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Paperwork Reductia~n Act .~ t ,.ice
<br />Public reporting burden for this collection of information is : etimated to vart om a range of 10 hour, ... an
<br />average per response for some minor facilities, col 10 hours as .tn average per r sou.i,e for some major taewti~s, ~
<br />with a weighted average for major and minor Facilities nl' tR (tours per response, including time for reviewine
<br />inshuctions, searching existing data sources, gathering and maintaining the yam needed, and romplcting and t
<br />reviewing the collection of information. Send comments regarding [he burden e;iimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, ro Chief, Information Policy
<br />Branch, PM-223., U.S. Environmental Protection Agency, 401 ~1 Street, S\\', ~; a.hineton, DC 2CWli0: and to the i
<br />Office of Information and Regulatory Affairs, Office oFManagement and 8udre'„ \4ashington, DC 20503. i
<br />General Instructions
<br />1. If' form has been partially completed by preprintine, disreeard instructions directed at entry ol'thai information
<br />al-cady preptimed.
<br />2. Enter "Penniree Nameht4aiiing ,address (and facility nano.%location, if different)," "Perrnir r\'umber, "and
<br />"DischargeA~umher" where indicated. (A seperate form is required (or each discharge.)
<br />3. Enter dates beginning and ending ";Lloniroring Period" covered by form where utdicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Mensuremeni" data for each parameter under "Quantity" and 'Qualiq~" in units spnified in permit.
<br />"sl reroge" is normally arithmetic average (geometric average 1'or bacterial parameters) of all sample measure-
<br />ments for each parameter obtained during ",'Noniroring Period"; "Maximum "' and ",Minimum" are normalcy ex-
<br />treme high and low measurements obtained during "Monitoring Period. " (Note to municipals with secondary
<br />treatment rcquiremeah, Enter 30-day average of sample measurements under "Average, "and enter maximum
<br />7-clay average of sample measurements obtained during monitorine period under ",'vlazimum. ")
<br />6. Enter "Pennir Requirement" for each parameter under "Quantin•"and "Quuli(v" as specified in permit.
<br />1 7. Urder ";1'o E.r"enter number of sample measurements during monitoring period that exceed maximum (and'or
<br />mi.~imum or 7-day average as appropriate) permit requirement for each parameter. if none, enter "t7. "
<br />3. Cuter "Frequencv q(Analysis" both as "Sarnple,Neasuremenr"(actual frey•eency of sampling acrd analy.is used
<br />dw~ing monitoring period) and a; "Permit kequiremem" specified in permit. te.g., Enter "Coot, "for continuous
<br />monitoring, "//7" for one day per week, "l/30" for one day per month. '7/90" For one day pu quarter, etc.l
<br />9. Suter "Sample Ttpe' both as "Sump/e aleasurenrent" (actual sample type used during monitoring period) and as
<br />"Pennir Requirement " (e.g., Enter "Grab" for individual sample. "14HC"' for _4 hour composite, "r~;tA "for con-
<br />tinuous monitoring, ect J
<br />10. R'h.ere violations of permit mquicemem, are repetrted, attach a brief eaptanatixt to describe cause and corrective
<br />act;.ons taken, and reference each violation by date.
<br />1 1. If "no discharge"occurs during monitoring period, enter ".'~'e Discharge" acros form in place of data gnu y.
<br />t 2. Enter "Name/Tide o(Principai Execuri ve Officer" vetch "Si,¢narure of Principal lirecuri ce Ojjicer of -1 uthori~eel
<br />.4genr, ` "TelephoneNunrber, "and "Dare" at bottom of Form.
<br />13. Mail signed Report to Office(s) by date(s) specified nn permit. Retain copy for your records.
<br />14. Mo-e detailed instrunions for use of chi, Discharge,blonirorirx Keport (D.NR/loan may be obtained Irom Of-
<br />fice(s) specified in permit.
<br />Legal Notice
<br />This repot is required by law (33 U.S.C. 13[8; 40 E.F.R. 125.27). Failure to report ur lailwe to repot tru[hfidly can
<br />result in civil penalties not to exceed SI0,000 per day of violation; or iu criminal penahic, not to exceed 525,000 per day
<br />of violation or by imprisonment (or not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 9-88)
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