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Paperwork Reduction Act Notice
<br />1'ub11C rC fdl'i l~ fills ~cq f(n iilU ...!iIC,IIUn U' I^I-Urma ell^ K rGhIT1a'~-iI In „a~~ rm..~ _~ _~ JI! h..u r. u~ a_
<br />average per response for some minor facilities, to 110 hours as an averagz per respn~se for~seme major facilitie.: I
<br />with a welgh[ed average for major and aunor taclhhzs of 18 hours per response, including time for reviewing
<br />tnsllvctions, searching existing data sources, gatherine and maintaining thr, dares ^eeded, srd compl.:ting and '
<br />reviewing the collection of information. Send comments regardme thz hurrlen esrima!z or any ether asput of I
<br />lhls collection of mfnrmauon, including svggrstions For reducing this burden, to Chief, Iuful urniiun Pniiry
<br />Hranch, PM-223, U.S. Em•Irenmental Yrotecuon Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of loforomuun and Regulatory Affairs, Office of Management and budget, Washington, DC 20503.
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<br />General Instructions
<br />1. If (arm has been nartially r•.nrnpletPd b; preprinting, disregard instructions dirwtad at antsy ~f lhxi infurmatron
<br />already preprinted.
<br />2. Enter '1'enniflee ,4'ome'A1mlinA addrr'~.i (and facility name/location, if different)," "Pe••ni! ,4+u^r~ticr " a:.d
<br />"Dlec i+uri{e ,1'umher" where Indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginnme and ending 'alonr;nrrn,~ Prrmd" covered by form where indicated
<br />4. Enter cacti "F'ornmclcr" as spccdicd In m~ nltonng requtrcmcnts of permit.
<br />5. Enter ".\'nnrplr• 11ran:rrmrnr" d., L1 for each parumclcr under "Quonirrv" and "Quolirv" m units specified in permit.
<br />"-1 rrrage" is normally anthmetic average (gaomctnc average for bacteri:d parameters) of all sample measurements
<br />for each paramclcr oblaincd Jdliub ".'./nn+luiin,p I'rrnru"', 'afnxununr" and ",11+renuun" arc nornally extreme high
<br />and IoH measurements oblaincd during ".llwvrorrng 1'enud " (Note to municipals crilh secondary treatment
<br />:cgvircmcnt~ Cc:cr'0-dn...^„_~ag.. u. ca,~,plc n iasulclncnu uad.r ~.ivrragr.' and en!~: --.•.uuum 7-da}' average
<br />of sample mcasurcmcnis oblaincd during monitoring period under ",1 faxinuun. ")
<br />6. Emcr "Pennrr Requlremenr" for enrh paramclcr tinder "~!!en!inf and "Qvnl:r}'' s spcrrcl in permit.
<br />7. Under "Nrl Fr" enter man!ber of samp!e n:ca:urmcnL darn(; monitoring p.:rod !hat ~acced ttlaximum (;utd/or
<br />minimum uI 7-d.,. e, cldgc ~ applupu.uc) pcu~nit req~li+enlem (ur each pammc!er It none, en!er "0".
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<br />... C^.!CI rrequ:rcr ry .;raa~s+s o,h ;;, ':I~„ly,~~ ,tlr~.,~rnl~ru" (e~iwi ilcyuenc} of sampung aria anatysls uses
<br />" during monitoring pcnod) and as "Pernut Rrgmrenam!" specified m permit (r R , Enter "('nits," for conlltttlous
<br />mnni!oring °l.7° I, 'nr d: } rcr r ter?:, '' JO" fc, _„_ ~~ i;_. ,..o.i.':', .. ....,..~ day pu yu:~.e:, i
<br />9. Emcr "Sampir rt1~r` iw!iI as ".~anrpa• 11ran+rcn,rnr' (,ctn:Il smlpi^ t,~. ! d!tnng monitoring ,'rod; 2nd -
<br />"Pennri Requirernenl." (c.g., Enter "trrah" for Indntdual sample, "7a//r"' for 24-hour composite, "~:1" I~ar
<br />e4I'dinuuUS ilwwtul rng, clc.)
<br />10. Where violatiotts of permit requirements arc reported, atmch a brief e.cplanation to descrbe cause and rnrrective
<br />actions taken, and reference each violation by date
<br />l 1. <<"no discharge" occurs during monitoring period, enter "Nu Uischnrge" across form in place of data entn.
<br />12. Enter "Namelfirle oJPrincipal Executive O]Tcer" with ".Signature ojPrincipa! Executive Officer ojAuthorized
<br />Agent," "Telephone Nunther," and "Dare" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in pertttit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afoniroring Report (DAfR) form may be obtained from Offce(s)
<br />specsed in permit.
<br />Legal Notice
<br />Tbis 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 x10,000 per day of violation; or in criminsl penalties not to exceed x25,000 per day
<br />of violation, nr by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
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