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'I ~4S reec.rn ~.rrt'.uaian Act T•tir.~e --- -- -
<br />1'ut;S: ,zportu.g burden for this wlleuuon ~f uU,~nunt~.,^ is rsti.matzd G~ ~.,ry from a range of i0 hours as .an
<br />I average per rzsponse for some minor facilities, to ] ]0 hours sus an aver;lr_ pzr ~;pon><: for some major facilities,
<br />' with a weighted overage ..:r 1na)l,c _r.~i ::.I;,.:r ta~lhpcs of l£t hours per ..~'scmz, inauding time for revjewing
<br />instn:ct~ons, xarchir.p exi ~hng da, e ,~.ur e,, ~a[hen.t ~ .i ~namtainu~g the d.,ta needed, and completing acrd
<br />revizwing the collzcnon .;t intbmntwn. S.:nd commcr,.s :zeardiog [hu nurden estimate or any~othel sapec[ of
<br />Phis collzction of i.^.form.e;ion, including ~:uygestion, r rzducutg this burden, to Chief, Information Policy
<br />Branch, PPd-223, U.S. Ee•..runmzctal Pwt.ction ;\~:n_ , 401 M Street, SW Wscshinf;ion, DC 21146(1; and to the
<br />OfficC u(Information and Feguiatory Affairs, Office ur :.1~nagemenl and Budget, Washington, DC 20503.
<br />General Instructions
<br />L If form has txen partially wmpleted by proprin[ing, disregard instructions directed et entry of Ihat information
<br />already preprinted.
<br />2. Enter 'Permillee .Nmne!bfaihng Address (and facility namdloca[ion, if diH'en:nt)," "Permit Number," and
<br />"Discharge Number' v,here indicated. (A separate form is required for each discharge)
<br />3. Enter dales beginning ar:d ending °.4foniroring Period" covered by Corm v+here indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. FNCr "Smnp:e 9feosur.•r;,ent" data fur each param•acr under "Quantity" .and "QuaLty" in units specified in permit.
<br />".-1ve"ego" is nornt.diy ,-.:;thmciic average (gemretnc average !or baclerisd parameters) of all sample measurements
<br />Cor each par.uneier ob'a,.i.:d daring ",1onitoring Pern,d"; "A~[aimurn" wind "dlinimum" are normally extreme high
<br />;uad low mcasuresuecLS obtained during ".1luniruring Period." (Note [o municipals with secondary Ue:rlmenl
<br />requirement: Enter 3:!-::zti• av: rage of sarnple mcasurcmenL: under "Average," and enter maximum 7-0ay avemge
<br />of sample measurcmeuts obtained during monitoring period under "Afaxbnum.
<br />6. Enter "Fermi! Requirc,,;r nt" for each parumeter under "Quantity" and "Quality" as specified in permit.
<br />7. Under "No F_x" enter :.amber of sample measurnrents during monitoring period Ihat exrxed maximum (and/or
<br />minimum or 7-day av~rge srs appropriate) pertni[ requirement for each psuameter. U' none, enter "0".
<br />8. Enter "Frequency nJA,.a?vsi.c" bosh as "Sample .lleasurment" (actual frequency cf sampling and analysis used
<br />during monitoring perio'.)~and as "Permt Requirement" specified in pcrrnit. (e.g., Enter "Cool," for continuous
<br />monitoring, "U7" fur ore day per week, "Ii30" for one day per month, "/'90" for one day per quarter, etc.)
<br />9. Enter ",Sample Type" bosh as ':Semple .tleasuremenr" (acural sample t}gre used during monitoring period) and as
<br />'Perunt Requ~remeru " e g., Enter "Grab" for individual sample, "7aHC' for ::4-hour composite, 'N/A" for
<br />continuous monitoring, zrcJ
<br />10. Where violations cC; grit requirements are reposed, attach a brief explanation to describe pose and corrective
<br />actions taken, and refcrerro each violation by date.
<br />11. ~ "no discharge" ocass i tiring monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter ".None?.Tle GJ. i r.ncipal :~Tecuhve Officer" with "S}gnarure oJF'rincipa! E.recurive Officer ojAulhorized
<br />Agent," "Telepl:are A'un;hcr," and "Date" at bottom of form.
<br />13. bfaa signed Report tc Office(s) by dale(s) specified in pemai[. Retain copy for your rerords.
<br />14. ~4ore detailed instructions for use of this Discharge Alonita•ing Repors (DhfR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />'''t:is czpcrt is r~^,quired by I;w (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to repoR truthfully can
<br />result is cis it , zna[ties cot ,, : zcrul S ~ 0,000 per day of violation; or in criminal penalties not to exceed (25,000 per day
<br />of v;olation, er by i,rfriso: R~es~. for not more than one year, or by both.
<br />EPA Farm 3320-1 (Rer•. 0~-YS)
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