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Paperwork Reduction Act Notice
<br />Public reporting burden For this collection of information is estimated [o vary from a range of 10 hours as sin
<br />average per respotse for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data Deeded, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collertioD of informatioD, including suggestions for reducing this burden, to Chief, Information Pclicy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 204b0; anal to the
<br />Office of information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has beep partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter ~Perntitlee Name~.llaibng Address (and facility namelloca[ion, if tlifTerenq," "Perini! Number," and
<br />"Discharge A'umber" uhcre indicated (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ".lfonitoring Perind" covered by form rs here indicated.
<br />4. Enter each "Parameter" as specified to motitoring requirements of pernut.
<br />5. Enter "Smnple afeasurenrent" data for each pvamcler under "Quantity" and "Quality" in units specifed in pennil.
<br />".-lvera~e" is nonnalh arithmetic avemge (gcoractnc average for bacteria' para-nc[ers) otall sa:rplc measurem~n[s
<br />for each parameter obtained dunng "Afnnituring Pcrin~9"; ",[forunuw" and "Slinimwn" arc normally extreme high
<br />and low measurements obtained dunng ".1Ju~ritoring Penud." (Mute to mcmcipals with secondary treatment
<br />requiremenC Enter to-day average of sample mesurcmcnts under "Average," atd ent_ maximum 7~ay average
<br />of sample measurements obtained dunng monitoring period under ",tlnximum.
<br />6. Enter ",Permu Requirement' for each paiamcler under "Quantity" and "Quoliry" as specified to permit.
<br />7. Under "No Ex" enter number of sample measurmenls during monitoring period that exceed ma~timum (ancVor
<br />minimum or play average as appropriate) pem~it requirement for each pa-arncler. If acne, enter "0".
<br />8. Enter "Frequency ojAnolvsis" both as ".Semple ,tfeativrmen!" (actual frequency of sampling and analysis used
<br />during litonitoring period) and as "Fermi! Re,uircutenP' specified in permit. (e g., Enter "Cons," for continuous
<br />monitotting, "li7" for one day per week, "I,'30" for one day per month, "1/90" Cor one day per quarter, etc.)
<br />9. Enter "$amp/e Tvpe" both as "S'amp/e ,tfeasurement" (actual sample qpc used dunng monitoring period) zed as
<br />"Permit Requirement," (e.g., Enter "Groh" fir individual sample. 2df/C"' for 23-hour composite, "Nif:" for
<br />rnntinu¢us monitoring, etc.)
<br />10. Where ~iolalions of permit requirements are r_ported, attach a brief explanation tD describe cause and corective
<br />actions )aken, and reference each violation by dale.
<br />11. If "no dpscharge" occurs dunng monitoring period, enter ",Vo Discharge" across form in place otdata entry.
<br />l2. Enter "pVnme/Title ojPrincipa! Executive O~rer" with "Signature ojPrincipn/ Executive Officer ojAulhorized
<br />Agent,"i, "Telephone Number," and "Date" at bottom of form.
<br />13. Mail si~ned Report to Office(s) by date(s) specified in perntit. Retain copy for your records.
<br />l4. More d@tailed instructions for use of this Discharge Afoniloring Report (D~LtR) form may be obtained from O6ice(s)
<br />specilietf in perntit.
<br />', Legal Notice
<br />This report is Fequired by law (33 U.S.C. 1318; 40 (:. F. R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than ono year, or by both.
<br />EPA Form 3320.1 ("Rev. 08-95)
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