|
Paperwork Reduction Act Notice
<br />Puhlic roporting burden for this collection of information is estimated to vary from a range of 10 hours as an ~~
<br />' average per response far some minor Facilities, to 110 hours ac an average nrr recnnpcN fr.r en..,P n„~~r facilities,
<br />~ .::!h ~ ...:.et::' :,.., ati.::,,r ::y.;r ;.i:d c~r.c: tau;ir,..~ .,, .o Lwr~ pc. iwpunac, umiuumg umz inr rewewmg .
<br />instructinn•:, sea n•iu ng ,-._~=t~r±g data sources, gathcriny u:d m.:in Licuag tha d::::: na:;il,:::, anu cmt,pleting +urd
<br />reviewing ibo wllectiun of informaiion. Send comments regarding [he burden estimate or any other aspect of
<br />~ this collection of mtnrmation, mcludmg suggestions for reducing [his fiurdrn, to Chief, ]nfurmatiun Policy
<br />ICI Branch, YM-"2`23, U.J. environmental Protection Agency, d01 M Sircet, SW Washington, DC 20460; and to the i
<br />Office of lnfa~atico ;_nd ^zbuatory Affair;, Offx of 1i:uwgumeni and Budgei, Cvashingtoo, DC 20503.
<br />`_ __ __. _ _ ._- _ - -.. --._ ._._ _ _ I
<br />General Instructions
<br />I. If form has been paRially complelzd by preprinting, disregard instrvctions directed at entry of that information
<br />already preprin[zd.
<br />2. Enter "Pernnrlee .4'nme :n indm~ .gddre.r.r (and lacthq' name,9oca[ion, if dilferenQ," "Penni( .Vun;ber," and
<br />"Dischnrge Nmrhr°;" u~hcre mdica[ed. (A scpaiatn form is required for each discharge.)
<br />3. Fntcr dates bcginnin~ and ending "'lfunimrur.~ Per»nl" covcmd by form inhere indicated
<br />4. Enter each ~Parmnrtr-~' as specified m monuor.ng regmrements of permit.
<br />5. f.IllCr .4mnnfr lien currn~r nl" dnla nr rarh na ramrrcr order °~hcpnri(!" a!ld ! !rn.il;' IR !:'1!!S Spcr.~^d In Dernul.
<br />.. .. ~~ .. ^.. , .... .ii i~ ~~ ~r e.ie,
<br />a1 a1111.t LIJ UI JII Jdln
<br />.. i
<br />~• . ^n•• l•.p!TB^t' .. .'. FIT,e.'.C ^... ;Z,: (b: ,n',. _ °it,C SOi ba "ial p 1 plc u1Ca~UICn1eI1t5
<br />for rn, h pnanulcr obunn~:d dunug "ilr:nunrr»t,+ P"rind' "1!anrruun" and ",tLremum" n:r r.orntalk e~trcmc high
<br />and lore measurements eb!:iincd during "1Jr~nrhirrq~ Perna!" (Note to municipals ~•:i!F. sccondar}' treatment
<br />regwrcmem Fntc~ 'll-du} average of sample !ncasurcmcnts under ":I reroge," and enter c-._: alum 7~ay avemgc
<br />of sample mcusuremcnL abLti ncd during momlonng period under ".1lurimunr.
<br />6. Enter "Permit Reyuiremrnt" for each parameter under "Quonu(r" and "Quality" as speciS~cc in pertujt.
<br />7. 'Jnder „\'r ;~s" tn;a number of snmplc mdswruc,as uric[ molt;toring penod Ciz; e..uced rheximum (antUor
<br />minimum or 7-dat~ avemgc as appropriate) pernlit requirement for cacti parameter If none, enter'0".
<br />8. Enter "hrenuenc.r' of ,tnaivst.c' both ac "`.u»iple Sfru.ur»rent" (actual frequcnq' of sampling and analysts use:
<br />during mUnn Urllll peflodl and ac '";°erll»! li elr 111 r'enlCn/~ spei lllCd in nernlll ie !' r'nl Cr °t'On(," for r'nnlmnral5
<br />momtonng, "l./" for one day per uecA, "1x30" for one day per momh, "/~4(I" for one day per quarter, do I
<br />v. Euicr ".\'orupk 7)pe born as ~:iun;rle iirrnurrmrr:r" i,icluai c:uuni. ;tn~~ u~r!i donne nuuutnnne rx:riod) and as
<br />"Perna( Requirernemr," ice Enter "iir^h' for indivaiual sample "2dlil"~ for 23-hrnir cmnnocilc. "NiA" for
<br />continuous monitonng, etc.)
<br />10. Where violations of permit regwrements arc reported, attach a boat esplanauon to descnbe cause and conecucc
<br />actions taken, and reference each vnolatton b} dale.
<br />l 1. U"no discharge" occurs during monitoring penod, enter ",\'u Dischnr/;e" across form in place of data entry.
<br />l2. Enter "Name/title ojPrincipa! Executive Officer" it'rih ".1'ignnmre ojPrinctpal P:xecutive Officer oJAu(hanzed
<br />Agent," "Telephone Number," and "Date" at bottom of (orm.
<br />13. Mail signed Report [o Office(s) by date(s) specified in permit. Retain copy for }'our records.
<br />l4. More detailed instructions for use of this Discharge Alonitoring Report (D.4fR) form may be obtained from Office(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 $10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Fortn 3320-1 (Rev. 08-95)
<br />
|