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Paperwork Reduction Act Notice
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<br />Public repoaing 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 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 needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />tgis, collection of information, including suggestiors for reducing this burden, to Chief, Information Policy
<br />I~an~¢, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />gffice of Information and Regulatory Affairs, Office of pfanagement and Budget, Washington, DC 20503. ,
<br />general Instructions
<br />1'. If. form has been partially corttpl:red by preprinting, disregard instructions directed•at entry of that information
<br />i. i .#Iteady preprinted.
<br />I.~ Enter 'Permilfee .Nome tfai!ina Addrexc (and facility rtameJlocation, it tfifferenq," "Permit Number," and
<br />~ "Discharge .Number" where indicated (A separate form is required for each discharge.)
<br />,3: EGte~dates beginni:rg and ending "4fonituring Period" covered by (orm where indicated.
<br />4, Enter each "Parameter" as specified m monitoring requirements of permit.
<br />~5. Enter "Sample Aleasuremenl" data for each pamnteter under "Quantity" and "Quality" in units specified in permit.
<br />j ~ ; 'Average" is normally anthmetic a~•erage (^..eometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during ".tlomrwing Period'; ':4farimunr" and ".1lmimum" are normally extreme high
<br />and low measurements obtained during ",itonrrur+ng Period." (Note to municipals with secondary treatment
<br />requiremrrnc Enter 30-day average of c~mrle measurements under "Average," and enter maximutrt 7-day average
<br />- of sample measurements obtained during monitoring period under "t4faximr.m.'J
<br />b Enter "Permit ,4egviremen:" for each pa.-amcter t:nd~ r "Qumttity" and "Qur,liry" as specified in permit.
<br />' 7. Under "Nn Ex" enter number o sample measurnt,:nts during monitoring period that exceed maximum (and/or
<br />minimum or 7-da}~ average as appropriate) permit requirement for each patatrreter. If none, enter "0".
<br />t$. Enter "Frequency o1 Anntysis" Froth as '.Sample .tfeasurment" (actual frequenc}~ oC sampling and analysis used
<br />•a during monitcrinb period) and as "Pernrir Requ:remenr" specified in permit (e.g., Enter "Goof,' for continuous
<br />j - monitoring, "1.~7" for one day per week, "1 'JO" for one day per month, "1%90" for one day per quarter, etc.)
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<br />. inter ".Sample .Type" bo!h as "Snr,,~'e 4lencurtrner•r" (actual sample type used during monitoring period) and as
<br />"Pernrif Requirement." (c.g., Et:~cr "Groh" Cot ~r.~lividual sample, 24HC"' for 24-hour composite, "A%A" for
<br />,continuous monitoring, etc )
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<br />C~i ~~Vhere violations o' permit re4rcremrnts are reputed. attach a brie( explanation to describe cause and corrective
<br />~ actions taken, and reference each viol;aior. b~• data.
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<br />[~. If "no discharge" occurs dt~~ng mcnitorng period, enter `.No Discharge" across Corm in place of data entry.
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<br />(r2: ~hter ":Vame'frde ojPrincipal Execuriv~ C?~cer" rvith ".Signature ojPrincipal Executive Officer ojAuthorized
<br />- ;Agent," "Telephone Number," a,ui "Dote" a[ botio^t of form.
<br />Mail signed Report to Office(s) by date(s) spec ifird in permit Retain copy (or your records.
<br />More detailed instructiots fu: use of this Dr.cchargr .Llatitoring Report (DAfR) form may be obtained from O6ce(s)
<br />specified in permit.
<br />~_ ~ : Le~~9 Notice
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<br />_ r4Port is required by yaw (33 U.S.C. 131tS: ~.G C.F R. !^_5?7). Fad~o:e to report or failure to report truthfully can
<br />r i in civil penalties not to exceed SI G.O(rU per day of i rotation; or in criminal penalties not to exceed 575,000 per day
<br />o .~iolt+tion, or by imprisonment for no more than one y~"r. or by boih.
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<br />Ep~~Foirm 3320-1 (Rev. Ua-95)
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