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Paperwork R[rduc€:c+ri Act N~~ticr~
<br />Public reporting burden fur this ceilectio^ of inforrrwGc; a estimated ili ~~ar}' liom a rmge of ii~ Cwu ; as :+r~
<br />average per resl*~nsr fcr some rcnor fsc~Lties, l0 1 ZO h+~~r+ as an average . i : ~ ,~;. (or some mayor fa:~ilities. I
<br />with a weighted average for major andminur faci[itirs trf~ :S h~~urs per ~~ 1.~,, . .+,,~.ding hme fur re•.~iewmg
<br />mstnctions, searching existing data sources, gath:rirg ..nu noa~nt,ioirg . ~. 1. :. ~ 4J. anJ ,.e.mplel.ag and
<br />reviewing the collection of information. Senn eournerb regarding the 5.•tder ~:rm.~ie .:; ar,y othzr ~speCi of
<br />this collection of iaforrnatioo, including suggestions fcr reducing this b.aden, to Chiet; lufurtnalion Policy
<br />Branch, PM-223, U.S. EnvironmeoEaJ Protutiou Agency, 4G: ht Street, Stdi Washington, DC 20460; end to the
<br />Office of Information and Regulatory Affairs, Office of Manngemeot and Bualget, 'Nashingtoa, DC 20503
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<br />General Instructions
<br />1. If form hu been partially completed by preprinting, disregard instruct ons d+rc:;[e:i at entry of that information
<br />already preprinted.
<br />2. Enter "Permiffee Name%Mailing Address (and facility name/location, if diffcret)," "Permit Nwnber," and
<br />- 'Discharge Number" where indipted. (A separate form is regrmed for each discharge )
<br />3. Enter dales beginning and ending 'Monitoring Period" covered by form w Ih~ere indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5- Enter "Sample Measuremem" data Cor each parameter under "Quantity" .end "Quality" in units specified in permit.
<br />"Average' is normally arithmetic average (geometric average for bacterial parameters i of all sample measurements
<br />Cor each parameter obtained during ".4foniloring Period'; "Mciximunt" au:l ".tfinimur~+" are normally h lreme high
<br />and low measurements obtained during "donitoring Period." (Note io mu ticipuls with secondary treaLnent
<br />requirement: Enter 30-day average of sample measurements under "Avenge "and enter maximum 7-day avemge
<br />of sample measurements obtained during monitoring period under "Maxinnu».')
<br />F. Enter "Permit Requirement" for each parameter under "Qunntiry" and "Qv~rlify" us spc~t:ificd itt permit.
<br />7. Urder "No Fir" enter number of sample measurtnents during monitoti~tg ptrod that exceed maximum (andlor
<br />minimum or 7-0ay average as appropriate) permit requirement for each parameter. if none, enter "0".
<br />8. Enter "Frequenty ojAnalysis' both as "Sample h>easurvnen~" (actual fn_quzncy o; sampling and at+alysis used
<br />during monitoring period) and as "Perini! Require+aenl" specified in pernut. (e.g.. linter "Cone." fog continuous
<br />monitoring, "1/7" for one day per week, "IL30" for one day per month, "1~'t0" for one coy per quartc:, da)
<br />9. Enter 'Sample Type" both as "Sample ,LfeasuremenP' (actual sample h,p;: user during monitoring period) and as
<br />"Perntif Requirement," (e g., Enter "Grab" for individual sample, "2•'HC' for 2:-hour composiit, ''.V/ti° fcr
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to ~tescribe cause snd corrective
<br />actions taken, and reference each violation by date.
<br />l 1. If "no discharge" occurs during monitoring period, enter "No Discharge" across form .,~ place of data entr}•
<br />12. Enter "Name/Pitle ojPrincipal Executive Officer" with "Signature ojP"ircipnl Exrarurive Officer r,fAurhor.'z<•a
<br />Agent," Telephone Number," and "Dale" at bottom of form.
<br />13. Mail sigrted Report to Office(s) by date(s) specified in permit. ketain copy for }our retards.
<br />{4. More ddailed inslntctions for use of this Discharge ,Lfoni(oring Report (D.tfR) form map be obtained from. Vice(s)
<br />specified in permit.
<br />Legal Notice
<br />Tbis report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.2'7). Failure to report or faa!ure to report tru!hfulty car.
<br />result in civil penalties not to exceed $(O,OllO per day of violauoo; or in criminal penalties no; to exceed SzS,OCa per d..y
<br />of violation, or by imprisonment for not more than one year, or by bode.
<br />EPA Form 3320-1 (Rev. 08-95)
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