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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated [o vary from a range of ]0 hours as an
<br />average ~er respotvse for some minor facilities, to 110 hours as ao average per response for some major facilities,
<br />with a weighted average for major aad minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining [he data needed, and completing and
<br />reviewing the collation 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, l.'.S. Environmental Pro[ectioi Agency, 401 M Street, SW Wadting[on, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management sod 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 "Permirtee h'ame%4fai/ing Address (and facility name location, if different)," "fermi! ,Vunrber," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ",tfomroring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Eater ~',Sampfe Afcanrrement" data for each parameter under "Quantity" and "Quality" in emits specified •n permit.
<br />",t vemge" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for cagh parameter o6taincd during ".\lani(ur;ng Peruvl", "lfnxrmu+n" and ",lfirimurrr" azc normally extrem: high
<br />and low measurements obtained during ",lhn+lnnng Period" ;Note to municipals with secondary lrcatmem
<br />rcquiramenf. Enter 30-da}' average of sample mrasurcmcnts undo: "Average," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period under ".4laximum.'7
<br />6. Enter ",Pennr(Reavirement" fcr each pazame[e~ under "Quantrry" and "Quafiry" as specified in permit.
<br />7. Under ",4'o Es" enter number of sample measurments during monitoring perod that exceed maximum (andl0r
<br />minimum or 7-dal average as appropriate) perni[ requirement for each pararrtc!er. If none, enter "0".
<br />8. Enter "Frequency ojAnotvsis" both as ".tinrnp/e .t/ensurnrent" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Peron! Requirement" specified in permit. (e.g.. Enter "Coot," for continuous
<br />monitoring, "1.~7" for one day per week, "/~30" for one da}' per month, "//90" for one day per quarter, etc.)
<br />9. Enter "Sample Ttpe" both as "Sample .4leasw ement" (actual sample t}pe used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Groh" fiat individual sample, "2aHC" for 24-hour composite. ":\'/.9" for
<br />continuous monitoring, etc.)
<br />I0. Where ,violations of permit requirements are reported, attach a brief explanation to describe cause and correcGvc
<br />actions taken, and reference each violation b} date.
<br />11. If "no discharge" occurs during monitoring period, enter "A'o Discharge" across form in place of data entry.
<br />12. Enter "Name/!'ille ojPrincipal Executive Officer" wlth "Signature ajPrincipal Executive Dicer ojAuthorized
<br />Agent," "Telephone Number," and "Dale" at boi tom of form.
<br />13. Mail signed Repon to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. Marc d@[ailed instructions for use of this Discharge hfoniloring Report (D.t'fRJ form may be obtained from Offce(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C'. F. R. 125.27). Failure to report or failure to report truthfully can
<br />result in civil penalties not to exceed S10,t}(10 per day of violation; or in criminal penalties not to exceed $25,!}00 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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