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Paperwork Reduction Act Notice
<br />Public reportirtg burden for this co]lectioa of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to ] ]0 hours as an average per response for some major
<br />facilities, with a weighted average for major and minor facilities of 18 hoots 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, BC 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 "Pe,-mittee Namehtloiling Address (and facility namenoca[ion, if different)," "Permit Number," and "Gischarge
<br />Number" where indicated. (A separate form is required for each dschage.)
<br />3. Enter dates beginning and editing "Monitoring Period"covered by form where indicated.
<br />4. Eater each "Para,nzr~r"as specified in monitoring requirements of permit.
<br />5. Pntcr "Sa,aFle,a~su,-zmznt" data for cacti parameter under "~iwnrity" and Quelir}~" as specified in permit. ~fveradz"is
<br />normally arithn-c*.ic are,age (geometric average for bacteria] parameters) of all son-; •le raeasure~nenls fur each pzran:etcr
<br />obtalned during ",LL,r!r,ring Pznod'; "i:azinami" and i,iini;aum" are -rarma'ly c;;TCmc h]gS and low mCasur=mLLts
<br />obtained di!ring ":~•h.iih~ring PzrioJ". (Note to mw~icipals with secnndery trcatrc~,t rcgnircrnent: L-afar 3C-day a~~r-agc
<br />of srmple me~surem~nfs under '~fvz, agr,"and enter maximum 7-day av.rage of s_r*tpic mca~uremen's obG.ined du ing
<br />monitoring period under "Ivlzrimum.")
<br />~. ...:c-':~a~;:it R.t~e~ir2n~,vt" %or each parametur u..der "~it~~i~titf"and "Qrr_rli,; "as specified it ;ern':.
<br />7. ~ndcr "A'o ,°.x" ~i1tc: nunber u`sample mcaEUn::ncni oaring -nonito~in~ l.criod'J~~; _,:^_ccd rnvrimum (~rd'ar mi.~~ ~aun
<br />or 7-day a~~crage as zppropriatc) pemrit requirement for each parameter.: f none, enter "0"
<br />II. ~n _. "Fr~:pts~_~ y'.hr~l~•sis" both as "S1aiFL is/ecsru•sa,,::f" (z_tual f cquenc ~ r"s: npling tad rn~]ysis used during
<br />n;o.i;torag p;,ried) and as "Feirtit IL•qui, em ,:;" specified in pennil. (e.g. Enter "C•,.:!,"for contnuous moniCoring, "//7"
<br />fur ore day ,rer r:•ee'.c, "//30" fur one day per month, "1/90"for one day per quarter, etc.)
<br />9. F.r.,:. "S,~rrt,l: TyEz"both as "S~„iFlz ,Y;e: rig, enisi:!" (actt,i_1 sample type used during rronitoiirtg pr.:icd) and as "F~,,;,i!
<br />Rs fr!irarizN," (c.g. Enter "GrsE" for individual sample, 14K~" for 24-hour composite, "iJ/A" for continuous
<br />monitoring, etc.)
<br />10. `'•.'here Notations of permit reSuirements arc reported, attach a brefexp]anaticn to dcsciib; cause and corrv;tive actio•~s
<br />to be taken, and reference each violation by date.
<br />1 I. If "no disclrargc" occws during monitoring period, cater "No Discharge" across form in place of data entry.
<br />]2. tinter Nmne/Trtle of A-inciF~! Ex~cutivz O~~•er" with "Sigvturz of Priir_iF21 EX2CZ(11V2 Gfj%ezr of Arrt.'ra-i=~d
<br />Agznt, ""Tr!zphcnz Nuuibzr,"and "Dote" at bottom of form.
<br />13. ~c:ail signed Report to CfGce(s) by date(s) specified in permit. Retain copy for your records.
<br />'-:..tore detailed instructions for use of this Dischwge irlonitoring R.~~rt (D,YIR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal 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 both.
<br />EPA Form 3320-1 (Rev. 03/99)
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