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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours az an
<br />average per response for some minor facilities, to 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor fa<ilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, [o Chief, Information Policy
<br />Branch, PM-223, U. S. Environmental Protection Agency, 40] M Street, SW Washington, DC 20460; and to the
<br />Office of information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. '
<br />General Instructions
<br />1. if form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permtttee A'ame/,Llailing Address (and facility namellocalion, if difi'erent)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending 'itfonitoring Period" covered by form w:iere indicated.
<br />4. Enter each "Parameter" as specified in monitonng requrements of permit.
<br />5. Enter ".Sample tleasvrement" data for each parameter under "QvundN" and "Qual+R" in units specified in permit.
<br />"Average" is normally arithmetic average ;g~rometric acemge for bacierial parameters') of all sample measurements
<br />for each parameter cbtaincd dining ",tlnnuorirg Period"; "afaxtmuut" and ",llinimrun" arc normally extreme high
<br />and low measuremat~s obtained during ".tlontto,-ing Period" pole ~o municipals Hilh secondary treatment
<br />requirement Enter 10-da}' aeertge of sample measurements wider ".4vecage," and enter maximum 7~ap average
<br />of sample measurements obtained during monitoring period under ".llaximum. "}
<br />6. Enter "Fermi! Reyuireutent" for each pararndcr under "Ovanriry" and "Quality" az specified m permit.
<br />7. Under ".h'o Ex" enter number of sample measurntcnh during monitoring period that exceed maximum (und/or
<br />minimum or 7-day a~•crage as appropriate) permit requirement for each parameter. if none, curer "0".
<br />8. Enter "Frequency of Analysis" both as "'S'ample ,ilem-urmenl" (actual frequency of sampling and analysis used
<br />during monitoring period) and az "Permit Requirement" specified in permit. (c g., Enter "font," for continuous
<br />monitonng, "li7" for one day per week. "/,30" i or one da}' per month, "1/90" for one day per quarter, etc.)
<br />9. Enter ".Sample Type" both as "Sample ,lleasur^ment" (actual sample type used during monitoring period) and as
<br />"Perini( Requirement," (e.g., Enter "crab" for individual sample, "Zd/1C"' for 24-!tour composite, "A'/A" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each ~~olation by date.
<br />11. U "no discharge" occurs during monitoring period, enter ",'v'o Discharge" across form in place of data entry.
<br />12. Enter ".Narne//'itle ojPrincipal Executive O~rer" with "Signature ojPrincipnl Executive O,~cer aJAu[horized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Dischnrge Monitoring Report (piJR) 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 civi(1}enalties not to exceed S 10,000 per day of violation; or in criminal penalties not to exceed x25,000 per day
<br />of violation, of by imprisonment for not more than one year, or by both.
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<br />EPA Form 3320-1 (Rev. 08-95) ' ~~ ~
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