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<br />Paperwork Reduction Act Notice °,
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<br />Pu r: repotting burden for this collection of information is estimated to vary from a range of 10 hours as m
<br />i~i~rjige per response for some minor facilities, to 110 hours as eo average per response for some major facilities,
<br />wi~ih a weighted average for major and minor facilities 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 />~a~Cviewing tlne collection of information. Send comments regarding the burden estimate or any other aspect of ,
<br />t-6't~ollectioo of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />~ ,,PM-223, U.S. Eovironmeotal Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />I ~t~of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />'~ i ~ General Instructions -
<br />'-7f form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />i~~"` ready preprinted.
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<br />~~, teK "Permirtee Name/Mai/ing Address (and facility nameJlocation, J diH'erent)," "Permit Number," and
<br />i ~,t T~?ischarge Number" where indicated. (A separate form is required for each discharge.)
<br />E~"lyLpter dates beginning and ending 'hfoniroring Period" covered by form where indicated. '
<br />h~.;4 ~ .
<br />trrd.5~rtlea.each "Parameter" as specified in monitoring requirements of permit. .
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<br />~ittCl' "Sample A-fensvrenrenP' data for each parameter umler "Quantity" and "Quality" in units specified in permit.
<br />*. Average" rs normally arithmetic average (geometric average for bacterial parameters) of all sample meastrements'
<br />P3ch parameter obtained during "Monitoring Period"; Maximum" and "Minimum" are normally extreme high
<br />F r ~ .and, low measurements obtained during "Afoniroring'iseriod." (Note to municipals with sernndary treatment
<br />I iequtrement: Enter 30-day average of sample measutMtents under "Average," and enter maximum 7~ay average
<br />~f sample measurements obtained during monitoring period trader "Maximum.')
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<br />' 6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quality" as specked in permit.
<br />~~: l y.
<br />~:`>;?TJndei "loo Ex" enter number of sample measurmenfs during monitoring period that exceed maximum (and/or
<br />~ ;minigtum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
<br />~} ;Enter "Fre uenc o Anal srs both as "Smn le Mea`su[ment"
<br />~_ q y j y p (aclttal frequency of sampling and analysis used
<br />a ,during monuoring period) and as "Fermi( Requirement" specified in permit. (e.g., Enter "Coat," far continuous
<br />€. ~rtonitoring, "!/~" for one day per week, "1/30" for one d5y per month, "1/90" for one day per gtuuter, etc.)
<br />s .
<br />.;Enter "Sample Tvpe" bosh as "Sample Measurement"(actual sample type used during monitoring period) and as
<br />~ii, . Perritit Requirement," (e.g., Enter "Grab" for individual sample, 24NC' for 24-hour composite, "N/A" for
<br />iy • rontiauous monitoring, etc.)
<br />a . ;Where violations of permit requirements are reported; attach a brief explanation to describe cause and corrective
<br />~ :actions taken, and reference each violation by date.
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<br />If'no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />$ntCl' "Name/title ojPrincipal Executive Officer" with "Signature ojPrincipa! Executive Officer ojAulhorized
<br />~~ Agent," "Telephone Number," and "Date" at bottom of form.
<br />Mail signed Report to Vice(s) by date(s) specified in permit. Retain copy for your records.
<br />More detailed insWctions for use of this Discharge Monitoring Report (DAR) form may be obtained from Og'ice(s)
<br />specified in permit.
<br />Legal Notice
<br />ort 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 />civil penalties not to exceed 510,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />ion, or by imprisonment for not more than one year, or by both.
<br />3320-1 (Rev. 08-95)
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