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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 l0 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major factlities,
<br />with a weighted average for major and minor facilities of 16 hours per response, including time for reviewing
<br />instructions, 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 bunion, to Chief, Information Policy
<br />Brooch, PM-223, U.S. Environmental Protection Agency, 401 M Street, S4Y Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management end Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter ~Permittee Name%btaihng Address (and facility name location, if different)," "Pervnir Number," and
<br />"Discharge Number" where indicated. (A scpa:ate form is required for each discharge.)
<br />3. Enter dates beginning and ending ':tloni(aring Period" covered by form H•here indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit
<br />5. Enter "Sample ,tlrasuremen(" data for each parameter under "Ouonti0~" and "QuoliR%' in units specified in permit.
<br />"Average" is normally arithmetic average (gcoitetric a•;crage for bacterial paramxers) of all sample meastuemenis
<br />for each parameter obLlined during "alonitorir,g Prriud"; ".4faxunma" and "Afinonum" are normally extreme high
<br />and low measurements obamed during ".lfo,ruoring Perrod." (Note to municipals «ith secondary treatment
<br />requirement: Enter 311~ay average of sample measurements under "average," and enter maximum 7-day a•;erage
<br />oC sample measurements obtained during monitoring period under'Sllarinrum. J
<br />6. Emer "Pennii Requirement" for each parameter' under "Quamtyt}" and "Quality" as specified in permit.
<br />7. Under ~"No Ex" enter number of sample measurmcnts during monitoring period that exec-,.d maximum (and/or
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. U none, enter "0".
<br />8. En(er '~~Frequencv oj.Analysis" both as "Same/e A4easurmenP' (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Perna( Reyuirena•nP' specified in permit. (c. g., Enter "Cont." Cor continuous
<br />monilo~ing, "li7" for one day per week, "!%30" for one day per monL't, "f/90" far one day per quarter, etc.)
<br />9. Enter '"Sample Tvpe" both as "Sample bleasuremenr" (actual sample qpe used during monitoring period) and as
<br />"Perm[( Requirenren(," (e. g., Enter "Grob" for individual santple, "2dffC' fur 24-hour composite, "N/A" for ,
<br />continuous monitoring, etc.)
<br />(0. Where ~iviolations of permit requirements are reported, attach a brief erplanalion to describe cause and corzective
<br />actions,taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring pen od, enter "No Discharge" across form in place of data entry.
<br />12. Enter 'tName.Ti(!e ojPrincipal Executive OJJ'cer" with "S'ignature ojPrinc(pal 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 copy for your records.
<br />14. More detailed instructions for ttse of this Discharge Afonitoring Report (DAIR) form may be obtained from Office(s)
<br />specifit#d in permit.
<br />Legal Notice
<br />'['his 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 penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed =25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
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