Paperwork F.eduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 hours as m 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, gat},zring and maintaining [he 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 burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Information 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 a[ entry of [hat information
<br />already preprinted.
<br />2. Enter 'Permi!!ee Name/,4failing Address (and facility namellocation, it different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate Corm is required for each discharge.)
<br />3. Enter dates beginning and ending 'ilfoniroring Period" covered by form where indicated.
<br />4. Enter each "Parmneter" az specified in monitonng requiremcnls of permit.
<br />5. Enter "Sample .lfeosvremenr" data far arch parameter under "Quantity" and "Quality" in units specified in permit.
<br />"A~~erage" is normally arithmetic average (geometric average for bacterial parameters) of all sample measuremeou
<br />for each parameter obtained doing ".tlomrorirg Period'; ".4fnximuni" and ".Minimum" are normally extreme high
<br />and low mcasurcrnenu obtained during ".11o.~itonng Period." (Dote to municipals ~~ith secondary treatment
<br />requirement] Enter 3fl-day average of sample measurements under ",{verage," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period under ".ifaximum.'J
<br />6. Enter'Pennit ReguiremenP' for each parameter under "Quanrih" and "Quality" az specified m permit.
<br />7. Under "!\''n Ex" enter number of sample mcasurments during monitoring period that exceed maximum (and/or
<br />minimum or 7-day acerage az appropriate) porn pit requirement for each parameter. if none, enter "0".
<br />8. Enter "Freyuency ojAnalysis" both as "S'ample .'tfeasunnenP' (actual frequency of sampling and analysis used
<br />during monitoring period) and az "Pervnir Reguiremenf" specified in permit. (e.g., Enter "C'ont," for continuous
<br />monitoring, "1 ~7" for one day per week, "1:30" for one day per month, "1/90" For one day per quarter, etc.)
<br />9. Enter "Sample Ttpe" both az "Sample ,IfeasuranenP' (actcal sample type used during monitoring period) and az
<br />"Permit Reguiremenr," (e.g., Enter "Grub" for inditidual sample, "?~/fC" far 24-hour composite, "1//A" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requiremenu are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "A'u Discharge" across form in place of data entry.
<br />12. Enter ",NameiTille ojPrincipal Executive Officer" with "Signature oJPrincipnl Executive Officer oJAulhorized
<br />Agent," "Telephone Number," and "Dale" a[ bo.tom 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 use of this Discharge Afonitoring Report (D.NR) forth tray be obtained from Office(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 $10,000 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. 08-95)
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