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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) <br />