|
Paperwork Reduction Act Notice
<br />,.
<br />F.repoRing burden for this collection of infonnatioe is estimated to vary from a range of;k(lhours as ae
<br />e per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />~eigllteQ average for major and minor facilities of 18 hours der response, including time for reviewing
<br />instructioos, searching existing data sources, gathering and tnaigtgJuing the data needed, and completing and
<br />reviewing the collection of information, Send comma ~ the burden estimate or any other aspect of
<br />this collection of information, including suggestio - Bing this burden, to Chief, Information Policy
<br />&artch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />t~ll'tcy of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />form hu been partially completed by preprinting, disregard instructions directed at eotry,of that information
<br />~Y Prieprinted.
<br />r
<br />ter "Permittee Name~.titailing Address (and facility namdlocation, if different)," "Permit Number," and
<br />i.+<eJrarge Number" whera indicated. (A separate Ccim is required for each discharge.)
<br />~•~ ~ 1 '+fonirorin Period"covered b form where indicated.
<br />~Atepdates beginning and coding '. g y
<br />~ute[ each "Parameter" as specified in monitoring requirements of permit.
<br />`Elmer "Sample Afeasuremcnt" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"AveragF" is ^orntally arithmetic averagge (geometric average for bacterial parameters) otaJl sample measurements
<br />for each parameter obtained during "A6an'i!oring Perlod'; "Maximum" and "il4inimum" are normally extreme high
<br />and low measurements obtained during 'rl;~niroring Period." (Note to municipals with secondary treatment
<br />requirement: Enter 30{lav average oC ta,nple meastuemcnts under "Average," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period under "Afaximum.
<br />Enter"Permlr Requiretnenr" for each paramcer under "Quantity" and "Quality" as specified in permit.
<br />",Vq Fx" enter number of sample meazunrtents during. monitoring period that exceed maximum (and/or
<br />rm or 7~ayaverage as appropriate) permit requirement for each parameter ff none, enter "0".
<br />F. Enter; "Frequenty of Ann~ysts" both az "5'nutp/e /Lfeasvrmenr' (actual frequenry of sampling and analysis used
<br />5 during monitoring period) and az "Permit ReyuirrrnenP' specified in permit. (e.g., Enter "Cool," for continuous
<br />' monitoring, "I ~7" for due day per week, "I •JO" for one day per month, "1/90" for one day per quarter, etc.)
<br />:'Enter "Sample Tjpe" both as "Sample 1~Jenwrerrrent" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e g., Enter "rraL" for individual sample, "24NC' (or 24-hour composite, "N/.9" for
<br />rnntinuoas monitoring, etc.)
<br />[4' Where violations of pernre requirements arc reported. attach a brief explanation to describe cause and corrective
<br />actiotls taken, and reference each violation by date.
<br />~c~. ]f "na discharge" occurs during monilorioo period, enter "No Discharge" across form in place of data entry.
<br />2. Enter "NameJTitle of Princrpal Erzcu:;ve O~crr" with "Signature ojPrincipal Executive Officer gjAuthorized
<br />Agenf," "Telephonz ,lrumber," and "Dare" at bottom of form.
<br />Mail signed Report to t7ffce(s) b}' dates} s,,^.a,ified in permit Retain copy for your records.
<br />' ~1, More detailed instn:cnons for use of this liischarga hfautoring Report (DMR) form may be obtained from Office(s)
<br />specified in permit.
<br />~~-' : ' Legal Notice
<br />it
<br />' .tgpott is required by law (33 U.S.C. 1P8; 4u GF.R. ] L5.27). Failum to report or failure to report truthfully can
<br />t iq civil. penalties no: to exceed $10,000 per Jay of vrolation; or in criminal penalties not to exceed 525.000 per day
<br />o tiiolation, cr by imprisonment for not more tlrsn one year, or by both.
<br />1r
<br />s•
<br />?i
<br />Ee~ Form 3320-1 (Rev, 08-95)
<br />
<br />
<br />c
<br />1~,
<br />k'
<br />
|