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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 hotus 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, 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 ah-eady
<br />preprinted
<br />2. Enter "Per~irittez Name/Mailing Address (and facility name/location, if ditl'eren[)," " Pernti! Number," and "Discharge
<br />Number" 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 "Parameter" as specified in monitoring requirements ofpermit.
<br />5. Eo[cr "Sa,nple rl4avrramcnt"data for each parameter under "Qeartity"and QualiO~" as spcciGed in permit. Averloe"is
<br />normally a,ithmetic average (geometric average Cor bacteria] parameters) of all sample measurements for each prrnnreicr
<br />obtained during ";v,'vni[oring Period'; "I~la±%rvu,»" and l~fi»ir» rna" are normally e;acme high acd low measrs:mcnt.;
<br />obtaiucd daring ".'.I,niloring Period". (Aiete Lo municipals v.~i[h secondary ueatTent requircmc-rt: i;nrcr 30-day a~c:dgc
<br />of sample rncasuremcnls under "Ave:aoz,"and enter maximum 7-day average of semplc mcasuremc:,ts obtai tzd du ing
<br />monitoring period under "ivlaximum.")
<br />6. L-n'cr "Penal! R ~rirement"for each parameter under "Qa~a»tih~" aztd "Quality" as specified in perm':.
<br />7. Under "!da Cs" ea'ur number o"eample measuren-.cnt eating monitoring peried ilia e~cecd maximum (andror rti~~;mu n
<br />or 7-day a!-crage as appropriate) permit requirement fur cacti parameter. ]f none, enter "G ".
<br />8. ~n er "F'.~ r~e;r_y ~~`:ur.rfjsis" both as "S~u;pfe .'vii ~s,rrama,rt" (actua[ fTcqucnc;~ of sanp(ing and anrlysis ^sed dur c,
<br />~nonitaru~g period) rnd as "Pennir R,z:lui: Win, ant" sped fic3 in. p,:r[nit. (c.g. SnLr "G.n!,"for canGnuoes monitoring, "1/7"
<br />fur one a:_y per v: ec'c, "1/30" fo: one day per month, "//9G"for one clay per quarto:, etc
<br />9. Rn.c. 'Sa~at.le ;ryF,"both as "S_~,»p/~ Si_asr,•e+narr"(actual sample type used during monitoring period) and as ",°cr-rni!
<br />ft:.7ei,e;;u.rt," (e.g ~nier "Groh" for individual sample, "24lfC" for 24hora composite, 'SViA" for conSnueus
<br />monitoring, etc.)
<br />f0. l'.'here violations of percrit requirements arc reported, attach z brief expianaliun to describe catse and corrective actions
<br />to be tacen, and reference each violation by date.
<br />11. 1f "no ruscitarge" occurs d.:ring monitoring period, enter'No Discharge" across form in place of data entry.
<br />72. Srte: "T.rarre/Title of Principal Exzcutivz ~~•_r" wif}r 'Sigmaturz oj' Frin.ir,~ri E.rscutivs ~cer of Aut/rcr%zaJ
<br />Agent, ""TcfcpJrorr~ Number,"and "Dan"at bottom of form.
<br />13. i~.ail signed Report to Cfiice(s) by date(s) specified in permit. Retain copy for your r,,co~s.
<br />'.4. ?riore detailed insGVCtions for use of this Discharge Monitoring Report (D>t92) form may be obtained from Of$cc(s)
<br />specified in permit.
<br />Legal Notice
<br />Ttvs 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 3326-1 (Rev. 03199)
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