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Paperwork P:eduction 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 I ]0 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 (or reviewing
<br />ins[ruc[ions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, to ChieF, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Offce of Management and Budget, Washington, DC 20503.
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<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed a[ entry of that information
<br />already preprinted.
<br />2. Enter 'Permittee Narne/eLloifing Addre.cc (arid facility name location, if di8'erenl)," "Permit Number,' and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dales beginning and coding ".tfoniroring i'eriod" covered by form where indicated.
<br />4. Enter each "Paramet,:r" as spectfied in monitoring requirements of permit.
<br />5. Enter ".Cample Afeanvemcnr" tiara for each pazamctcr under "Quantity" and "Queliry" in units ;p,,cscd in permit.
<br />".d~.~eruge" is normally arithmetic avenge (geometric average for bacterial parameters) of all samp;c measurements
<br />for each parameter obtained during ';llnpi(uring Prrio~N; ".ifarinuun" and '7rlini~nwn" are normaily extreme high
<br />and low mcasurcmenls obtained during ".1laritunng Per,ud." (Note to mun;apals eith secondary treatment
<br />rcgwremcnt: Emcr li'-day a~cragc of sample mcasurcments under "avernge," ar.d enter maximum 7-day average
<br />of samp)e measuremtnts obtained during monitoring period under ".1lnximmn.
<br />6. Enter "Permit RequirrnenP' (or each parameter under "Quantity" and "QuaLiy" as specified in permit.
<br />7. Under "N'o Er" toter number of sample measurmenis during monitoring ceriod that exceed maximum (and/or
<br />minimum or 7-day average as appropriate) pcrniil rrquircment for each paramelci. If none, enter "0".
<br />8. Enter "frequency of.dnolvcis" both as ",Sampde .tlea.mrment" (actual frequeno~ of sampling and anal}'sis used
<br />during monitoring penod) and as "Fermi( Regvirentenr" specified in permit. (e g., Enter "Cant," for con[i tuous
<br />monitoring, "1/7" for one day per week, "/,~30" for one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter 'l$ample Type" both as "Sample Aleasrrantent" (actual sample t}pe used during monitoring period) and as
<br />"Permit. Requirement," (e.g., Enter "Groh" for individual sample, "2JHC' for 23-hour composite, "N/A" for
<br />continuous monitoring, etc.)
<br />10. Where violations oC permit requirements are n:ported, attach a brief explanation to describe cause and corrective
<br />actions (alcen, and reference each violation by date.
<br />11. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/title orPrincipal Executive Officer" with "Signature ojPrincipa/ Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Date" al bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain rnpy for your records.
<br />14. More detailed instructions for use of this Discharge Afoniroring Report (DA4R) form may be obtained from Offce(s)
<br />specified in permit.
<br />Legal Notice
<br />1Lis report is required by law (33 U.S.C. 1316; 40 C.F.R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil petatlties not io exceed 510,000 per day of violation; or in criminal penalties not to exceed $25,000 per day
<br />of violation, or by imprisocment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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