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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 I8 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, 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 enhy of that information already
<br />preprinted.
<br />2. Enter "Peimittee Name/il~tai/ing Address (and facility name location, if different)," "Permit NunlFzr," znd "Ciscrerge
<br />Nuinbei' where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and editing "Monitoring Period" covered by form where indicated.
<br />4. Enter each "Paramzter" as specified in monitoring requ irements of permit.
<br />5. Enter "Sanzpfz Msasurenrent"data for each paran eter under "~uantiry"and ~aliry" as specified in permit. "Av.r~gz" is
<br />normally arithmetic ave3gc (geometrc average for bacterial pr~netcrs) of a!I sample ncasuremenls for each parameter
<br />obtained during "h~7,nitoring Pari~d'; "A4~riuur,n" and f~fi,ri,n!.on" a : no-ma!ly a.ar.rae hig;t and low meastrments
<br />obtained dw-ing "i•.1nni!o,-i,rg Fan.', a". (T~`o[c to m~ ~~cipals s1 :h seconc,ay treatment re:~uiremcnt L-rter 30-day ave-~gc
<br />of ;ample measureme^ts unr'cr "Avsraee,"and cn:er :-aximum 7dzp aeecage of sr,p'c measurcmcts ob`sned dung
<br />monitoring pcrod under "Maximum.")
<br />5. $nrrr "Poi nzit Rz~ui,te,ns;lt" `or each parameter under "i llwifih,'"r-nli "L 2!a/i1~"a5 F'CCI:~Cd Ll pL'rml:.
<br />7. under "N.~. /_'x" enter number of sample mcasuremect d~,uing ma-~ita.i-!, ,triad t~.at _ ;cr_1 m:xinun (and,'cr clin`mu:o
<br />or 7-day avcr•gc as appropriate) permit requirement for each panmetcr. If none, cats- "C".
<br />8. °rtc~ "Frai ~sr y cj An~/ysis" bo!'t as "So,r,,-le l~9r~.a :•a;:n~,rt" (acha] f.-cquercy o' ce mh,rg znd enalysis used du n,
<br />moo itaring per od) and as "Pzrali~ Rs?ui; ~•„lea!" spccir icd in pc-m it. (c.g. Enter ' ... ; ~. " .-ar continueus monito~ng, "r/7"
<br />fur one day per wee!y "l/30" for cnc day per month, "1/90" fo,- one day per quarter, e~_cJ
<br />9. :;n'e: "S,~,.y le TyFe" bo81 s 'S~mrL Lkasu;~e:.u;z1" (actual sarr,nle type used du;n~ monitor<ng *;criod) and as "Tz: %irt
<br />R.;3uira1;1~>,n," (e.g. Enter "Grate" for individual sample. "24;;~' for 24-hour cn.nposite, "r\'/h" for continccu~
<br />monitoring, etc.)
<br />10. CP.rerc violations of permit requirements arc reported, attach a brief explanation to dzscribc catse and corrective actions
<br />to be taken, and reference each violation by date.
<br />l 1, if"no discharge" occurs during monitoring period, enter'T'o Cischar~e" across form in place of data entry.
<br />12. Enter "Nam.;/Titf~ of Po-inciFal 6'xecutive Cffi.er" with "Sibnzanr;e cl Prin:ipa! E.racutiva Officer of Autkoi-i=ad
<br />Agent, ""TelaphoneNumbzr,"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 this Discharge Monitoring Report (D,1~ form may be obtained from Otlice(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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