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- Paperwork Reduction Act Notice
<br />litblic raportin~ burden for this collection of information is estimated to vary from a range of 10 hours as m
<br />ayarage per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />wit~,e weiy~ted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions,'searching existing data sources, gathering and maintaining the 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 />Brttncfi, 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 />.i~
<br />1.41f form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />'. glready preprinted. -
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<br />'~ 2.rEnter "Permittee .Name/Mailing Address (and facility name location, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate (ortn is required for each discharge.)
<br />~3, Enter dates beginning and ending iLfonirnring Period" covered by form where indicated.
<br />!A; inter each "Porarneter" as specified in monitoring requirements of permit.
<br />iiSt~Epter "Sample AfeasuremenP' data for each parameter under "QuanriN" and "Quality" in units spceifred m permit.
<br />~y' ~ ".overage" rs normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />t, ; for each parameter obtained during ".iLfoniforing Period'; "bfarintwn" and "Afinunum" are normally extreme high
<br />and now measurements obtained during "Monitoring Period." (Note to municipals with secondary treatment
<br />„ requiremenC Enter 30-day average of sample measurements under "Average," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period. under "Maximum.
<br />Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" az specified in permit.
<br />F7.~Undgr ",No Fx" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7-0ay average az appropriate) permit requirement for each parameter. If none, enter "0".
<br />.. f
<br />r8. $nlet "Fregvencv of Analysis" both az "Smnple rLfensurnrent" (actual frequency of sampling and analysis used
<br />during monitoring period) and az "Fermi! Requirement" specified in permit. (e.g., Enter "Cont." for continuous
<br />mhoniloring, "i/7" for one day per wcek, "l/30" for one day per month, "!/90" for one day per quarter, etc.)
<br />1=9.~$n[er "Sample Type" both az "Sample Measurement" (actual sample type used during monitoring period) and as
<br />;i, "Permit Requirement," (e.g., Enter "Grab" for individual sample, "14HC' for 24-hour composite, ".N/A" for
<br />'t: ,continuous monitoring, etc.)
<br />:Where violations of permit requirements are reported,'attach abrief explanation to describe cause and corrective
<br />-actions taken, and reference each violation by date.
<br />If "no discharge" occurs during monitoring period, errter'7Vo Discharge" across form in place of data entry.
<br />~. Enter "Nnme/fitle ajPrincipa! Executive O~cer" with "Signature ojPrincipnl Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Dale" at bottom of form.
<br />#). Mail signed Report to 08ice(s) by date(s) specified in permit. Retain mpy for your records.
<br />}~, More detailed instructions for use of this Discharge Monitoring Report (DA1RJ Form may be obtained from Office(s)
<br />speed in permit.
<br />Legal Notice
<br />(~s 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 />;69t in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />'VioF9tion, or by imprisonment for not more than one year, or by both.
<br />P~i Form 3320-1 (Rev. 08-95)
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