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Pa•rwork Reduction Act ]e?•~~:
<br />Yublir reporting harder, for this collation of informatiuu is estimated t+, . ; , ; - ~c: ; ^s ;,n
<br />average per resptmse (ur some tumor (acitities, to 110 hours as au evzrag~: ! :~ :.~ .. f:..~ilil~cs,
<br />w~ilh a weighted averagt for major and minor facilities ut '~ F hour, per a I+.~ ~ : ~'c ~,,:- ..,. r rc~ ,e.,,ug
<br />~ instnictiuns, searching existing data source, gathering a~~c! maintaining t ~. .~ .._. ...1 ,..._ _~,~r•pleLag m;a
<br />~ rr~virwing the collection of information. Send conunenL. n:gar,iing the :,.t..e: :..s..,c ,,, ~.} other a•,pect of ~
<br />ibis collection n( informatit+n, including scggestions to r;dacinl; [his t.cci_~,:, :u i. hie t, Ltt.~rrnatioo Poiicy
<br />Branch, PA1-223, U.S. Environmental Protection Agency, s.C. Pt Street, S`4 W~ hing:an, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of titansgement anu Budget, 'rVashroguio, DC 20503
<br />General Instructior~i
<br />1. if form has been partially completed by preprinting, disregard instructions directrc at entry of that information
<br />. already preprinted.
<br />2. Enter 'Permittee Nnme/Mailing Address (and facility name/loption, if different)," "Permit eVumber," and
<br />"Discharge Number" where indicated. (A separate forth is required for etch discharge.)
<br />3. Enter dates beginning and ending 'Monitoring Period" rnvered by fornt t~~here indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of perms i.
<br />S. Emer "Sample Measurement" data for each parameter under 'Quantity" and "Oval,n" in units specsrd in pertnit.
<br />"Average" is normally arithmetic average (geometric average for baderii. par:metci:;) of all sample mt~surements
<br />for each parameter obtained during "Monitoring Period'; "HJrarimum" end "i'vrirnum" are normally e;dreme high
<br />and low measurements obtained during "Aonitoring Period." (Note to nu.-ticipals with secondar,~ Irearmerr;
<br />requirement: Enter 30-0ay average of sample measurements under ".;v ragr,° and -enter maximum 7 jay average
<br />_ of sample measurements obtained during monitoring period under "bfaxi~num ';
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as sf~txified in permit.
<br />7. Under "No Ex" enter number of sample measvrments during monitoring period drat exceed maximum (andror
<br />minimum or 7-0ay average as appropriate) permit requirement for each Farame7er. li'nate, enter "0".
<br />B. Enter "Frequency ojAnalysis" both as "Sample Measurment" (actual frequcnc}• u( sampling and :;~alysis usd
<br />during monitoring period) and as "Permit Requirement" specified in p:rmi+. (e.g . Enter "Corry," for cotninuous
<br />monitoring, "I/7" for one day per week, "1/30" for one day per month, "1 '9C" far one day per quaver, cw.)
<br />9. Enter "Sample Tvpe" bo(h as "Sample Measurement" (actual sample qpc used du.;ng monitoring Qeriod) and as
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, .'.d!/C' for s4-hour wmposnc, "A',A" fo.
<br />continuous monitoring, etc.)
<br />10. Where violations oC permit requirements are repoved, attach a brief e~.i,lanation to describe cause m.d corrxt vc
<br />actions taken, and reference each violation by date.
<br />I l . If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of daa c: try.
<br />12. Enter "Name/TiUe ojPrincipaf Ezeeutive O~eer" with "Signature oji'rin~ipa! £aecutive Cjfcer~.'Aairorizec'
<br />Agent," "Telephone Number," and "Date" at bottom oCform.
<br />13. Mail signed Report to Q6'ice(s) by date(s) specked in permit. Retain copy Cor }our records.
<br />14. More detailed inswclions for use of this Discharge,tfonitori,ag Report (DAfRJ form may be obtained f=om .^.ffice(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 Lv report or failure to reportbvthfully can
<br />result in civil penalties not to exceed E10,000 per day of violation; or in criminal penalties not to rxcre:l 52S,OG:, per r;a,
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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