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Paperwork Tteiduction Act lattice
<br />Public reporting burden for this collection of information is estimated td vary from a range of 10 hours as an
<br />average per resportse for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />a weighted average for major and minor facilities of lB.hours per response, including time for reviewing
<br />~~tioas, searching existing data sources, gathering turd. j~liioltaining the data needed, and completing and
<br />tewewing the collection of information. Send commeafs amg 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, 40l M S[rezt, S`~/ Washington, DC 20460; and to the
<br />Office of Ia.formation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions-
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that inforrmtion
<br />already preprinted.
<br />2. Eater "Permittee Name/,1'failing Address (and facility nameAocation, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A sepaza[e form is required for each discharge.)
<br />3. Enter dates beginning and ending 'iLlonitoring Period" covered by form where indicated.
<br />4. Enter each "Paraneter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample hleasuremcnr" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />far each parameter obtain.d during ",14onitoring Period"; ".4~arimunt" and "A~inimum" are normally extreme high
<br />and low measurements o~tained during "Afonitormg Period." (Note to municipals tti~th secondary treatment
<br />requiremcnC Enter 30-dav average of sample mcastuements under "Average," and corer maximum 7-day average
<br />o(samale measurements ootaincd during monitoring period under "tifaximum.'J
<br />6. Enter "Penml Requirement" for each parameter under "Quantity" and "Quality" az specked in permit.
<br />7. Under "AJO Fx" enter number of sample measurrnents during ntonitor;ng period that exceed maximum (and/or
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. if none, enter "0".
<br />8. Enter "Frequency oJ.Ana/yci.c" both as "Snrnple Measvrment" (ocular frequency of sampling and analysis used
<br />during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "C'ont," for continuous
<br />monitoring, "!/7" for one day per week, "1/30" for one day per month, "1.90" for oue day per quarter, etc.)
<br />9. Enter "S7nnp,te Tvpe" both as "Sample Afeasuremenl" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e g., Enter "Grab" for individual sample, "24KC" for 24-hour composite, "N/,9" Cor
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, anach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />l 1. If"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/title ojPrincipal Executive Officer" tv~[h "Signature ojPrincipa! Executive Officer ojAutharized
<br />Agent," "Telephone Number," and "Date" at 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 derailed instructions for use of this Discharge Alnniroring Repot! (D~LIR) form may be obtained from Office(s)
<br />specified in permit.
<br />• Legal Notice
<br />Tltis report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27}. Failure to report or (allure to report truthfully can
<br />result in civil penalties not to axc:rd 510,000 per day of violatioe; or in criminal penalties not [o exceed 525,000 pet day
<br />of violation, or by imprisonment for not more that. one-year, or by both.
<br />EPA Form 332C-1 (Rev. OS-95)
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