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<br />Paperwork Reduction Act Notice
<br />'. R:blic reporting burden for this collection of information is estimated to vary from n range of 10 hours as an
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<br />•.i'~'h A \+'Cl nf•r•~~ ~ypml'C rtlr T'S~O- url._ InlnUr IZL'IIItI CS Of IB hoara pCr IeSl%11RC, melflU'fl" tITY fM fCVlYwmg
<br />inctroctions, searching existing data sources, gathe,ing and maintaining [hc lots n:,zaled,~and completing and
<br />reviewing [he collectioe of information. Send common LS regarding the burden esii male or any other aspect of ICI
<br />this collection of infornvlliun, including suggestions for reilucing ibis burden, lu Chiet`, infanrultioo Poiicy ~I
<br />Bench, PP.1-223, U.S. knvlrnnmeatsl Protection P.gency, 9U1 M 5tree[, 5W W•~.hmgtnr., ^!' 2^n~U; a;,d to the
<br />i Office of Information and Regulatory Affairs, Office of Management and Budget, Washington. DC 20503.
<br />General Instructions
<br />1. If forth has been partially completed by preprinting, disregard instruc[ioos directed at entry of that information
<br />already preprinted.
<br />2. Enter "Permi([ee A'ame;iLlailing Addrees (acrd facility rrarue/localion, if di~ercnl)," "Penni[ rb'uulber," and
<br />"Dschargc A'umb[,:=' +vhere indicated. (A separate term is required for each discharge.)
<br />3. i-:nice dales bcgunuug and uldmg 'Rfunimnng Fcru,d" covered by form where Indicated.
<br />,',"-:nic •'.r_h "P~ru,n, t..,_" err.,( in manitorir•~ r.-.rl.~.::•,ncn[s orpcrmit.
<br />, ~ ..,
<br />;:rr:~: '... ,.- . , ," d~L; .,r as°!, --° ,.:cr c-c.r ~u,rnr:n" and ".•^•:r,aify~" ,nits eei.'ied is emit.
<br />,:, ~... p.,. ~ "~ sp pc
<br />".!I•rrnnr" is nnnnalb: anthmetic average (gwmc~.rc'••.~c-2oe for bactcna! parameters) of all sample measurements
<br />for cock parameter ohtair.cd drrnno "4 /amarrn,q Prrinc% "1larrnr:nn" and ".'•.Imimurn" arc normally c-creme high
<br />and lo++ mcasurcmenls ebtuncd during ".llavronn;; 1'ennrl " (Note to municipals with seconda ;~ treatment
<br />requirement Enter 3U-dav average of s<vnplc measurements under ".Irrrn~c," and enter maximum 7-day average
<br />of sample mw,wcmcuts obt.rincd during nlm;r;onng period under ".t laxm::or.. ")
<br />6. F.ntcr "!'crnul Kcymremcnl" for cacl~ pv-urtci^r under °Qunnnn"and "(7n,;lfrj." sc spccifrcd in pcrmlt.
<br />7. Under ".\'vri" enter t:umbcr of sample mcasurnlcros c:eric ~ monitoring period Iha[ r.:cred maximum (and/or
<br />minimum or 7-dav acemec ns appropnatc) permit requitement for each parameter. Unone, enic~ "C".
<br />% Fnlrr "(~rrrlpr-nri nl .,nnii er c' nn10 aC 'SONinie ~~IYp.OrYaly%ll ~~ IAlll Cil IrCgnCllC}' Uf SIIIIpI:r r, L. P1 aum,Jl] hied
<br />dunng monrtaring period) and as "!'ermi( h'eguu-rn[eru" spxrhed to permit. (c.g., Enter '('ant," for continuous
<br />monitoring. "/ 7" ter r^~ ring per +•:cck, "1't~" ear m~^ r!nv per month "Lp0" for one day oCr quarter, etc )
<br />U Fnlrr "Cmm~ln 7bnr" hn111 at "Cnm ni,• 1/Pa,rlr'YglPIII" (:IChlal samol~ I+rc used dunne monnonne tKnoci aad ;ts
<br />"Porno[ Requvemru[." (e. g., Enter "Grab" (or indt+idual sample, "~ali("' for 24-hour composne, "' "' rnr
<br />continuous momtoring. etc.)
<br />10. Where violations of permit requirements are reported. attach a brief explanation to descnbe cause and corrcc;ivc
<br />actions taken, and rcfcrence each violation b}' date.
<br />I I. If "no discharge" occurs dunng monitoring period, enter ".1'o Drscharge" across form m place of data entry.
<br />l2. Enter "Name~!'ide ojPrincipal Executive Officer" with "J7gnarure ojPnncipnl Execunve Officer oJAu(horized
<br />Agent," "Telephone Number," and "Dare" at bottom oC form.
<br />13. Mail signed Report to Office(s) by date(s) specified in penllit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Aloniroring Repot( (D,41R) form may be obtained Gom Ollice(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 to report or failure to report truthfully can
<br />result in civil penalties not to exceed 510,000 per day of violation; or in criminal penalties oot to exceed E25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OH-95)
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