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<br />- - - : ~ .:-t~t~tion Acr: r (trice
<br />Pi:~'~c !:name; "c~~' - ~ - ` :nfnrrr~;,ti~~,n is estimated to ...: 40^ ,range of 10 hours as an
<br />ave:~ce n~.r r.. ;;.r,,r ~.~r s. .., ., ~ ~, ... n, ; ;(' h~ ~t~ as ttn aureole ;~ ~ e pon~: for some major facililie.:,
<br />wt[h a •.~'aigbted s.ea.~z t.:r n~~c. ~n~ uw,.,r tacri,t,os u( 18 hours per r.cspo.t:.e, in.luding time for reviewing
<br />:r.>tn:zt:,ms, ece:,h:r.l ex.: ._,. ..:;~,.:.< euther r; .,.*tainin;; ~~:ne .late weeded, and completing and
<br />ro~•izH~ing the wlletuun :.: ,:,or..~:ru,,. Sa;d conurci._. _;,erz.ing the burden estirmtte or any~othen aspect of
<br />this collation of ,n:;,mut.,~:;. ior!udmg -ucgcsti~~. c~ z!,~.:cg this ~~urd~~r., [o (fief, Inforrnalion.Policy
<br />SrarcL•, P1T ~2?. U.S En:.~un:r,:nt~l Prot.a:acn :'_., .,, -~ ~ .`.I Street, ~ 14 Washington, DC 20460; and to the
<br />Office of Information and F.rguiatory Affairs, C`fice ~~F .w.at:agememt and Hv,dget, Washington, DC 20503.
<br />General Instruction. s
<br />1. If form has been partially completed by preprieting, disregard ins[rucuons directed at sorry of that infonnat ioa
<br />already preprinted.
<br />2. Enter "Permittee h'am,.,l7ailreg Address (and facility nam/localion, if diH'erenl)," "Permit 7Vumber," tmd
<br />"Discharge Number" wlrzre indicated. (A separate form is rewired for tech discharge.)
<br />3. Enter dates beginning and ending ",dlonitoring Period" covrmd by form where indipted.
<br />4. Enter each "Parameter" ;s specified in monitoring requirements of permit.
<br />5. Enter ".Sample .lferuar:-..err" dote for each parameter under "Quontity" tmd "Qualirv" in units specified in pernil.
<br />".:Yernge" is normall} ::r:~hmeuc average (geometric wcrage: for badcnal pruameters) of all sample,measurements
<br />for rich parameter obw;ued dm;ng "A4onimring Ferii.d"; "Afaximum" w(d 'Afinimum" are normally extreme high
<br />and low mesuremerts .rbiarncd during "Afonironn!; Period." (Note to municipals with secondary treatment
<br />rcquircmenc Eater 3^-::a~ ave,.~ge of sample measurements. under "Average," and enter maximum 7-day average
<br />of sample measurements u~taino-l during monitoring period under "Afsnmvm.
<br />6. Enter "Penni(F,cyuire.nc rr" fee each paranteler under "Quantity" and "~'e~afity" as specified in permit.
<br />7. Under ".'.'o Ex" enter nt~nber of sample mcasunnents during monitoring period that exceed maximum (and/or
<br />minimum or 7day even ,;~ as appropriate) permit requirement for each parameter if none, enter "0".
<br />8. Enter "Freyuer,cv r j.ir. ~_'y;,s" Luth as "Sample Afensurmen(" (actua liequcncy of sampling and analysis used
<br />during monitoritig pero_) and as "Permit Reguirenren(" specified in p_rmit. (e.g., Enter "Cant," for continuous
<br />monitoring, "l'T' for ore day per -.vicek "I/30" Poe one da}' per month, "1-`.~0" for one day per quarter, etc.)
<br />9. Enter ".Cmap,'e 7vpe" be.h as ".~omple :9easurernenr" (actual sample [}pe used during monitoring period) and as
<br />"Permit Regviremerr." ,z.g., °ater "Grab" for individual sample, "1JNC' for 24-hour composite, "N/~!" (or
<br />continuous motutorin, e;c.)
<br />i0. 1Vhere •,iolauons of )~erndt requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and refarc: ce each violation by date.
<br />11. )f "no discharge" urea s luring motutoring period, enter ".Yo Discharge" a~crass fore in place of data entry.
<br />12. Enter ":Vmne.Tvle oj'P,•.~aupal L~ieculive Officer" vxilh "S9pna(ure ojYrincipal Executive O~cer ojAurborized
<br />.agent," 'Telephone ~'au.i n•," and "Date" al bottom of farm.
<br />I3. Marl signed Report to CtFtce(s) 6y date(s) specified in permit. Retain copy for your records
<br />I4. A4ore detailed ittslntuie^:: fur use of this Discharge Afnni(oring Repot! (').AIRI form Wray be obtained Gum O0ice(s)
<br />specified in permit.
<br />Legal Notice
<br />'!'tis repai is required by I::w ('.3 U.S.C. 1118; 40 C.F.R. 125.27!. Failure to report or failure to report truthfully can
<br />resuU :n civil penahiae net ~ . ~.~:Wad D;t),000 per day o(violalion; or in ctitrrm d penalties not to exceed 625,00(1 per day
<br />e(violaticn, er by imprison:~::.i ;or ^, t more than one year, or by both.
<br />EPA Form 3320.1 (Rev. 0 :-45)
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