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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated [o vary from a range of 10 hours as an
<br />average per response for some minor facilities, to ] 10 hours as an average per response for some major facilities,
<br />with 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 tnaintaiatng the data needed, and completing and
<br />reviewing the collection of information. Send anmments regarding [he burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 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 'Permittee A'ame.~failing Address (and Cacility nameJlotation, if diH'erenl)," "Permit Number,' and
<br />"Discharge Nvrnber" where indicated (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending 'Afonituring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitor rig requirements of Pcrmil.
<br />5. Enter "Sample ,Ifeasurement" data for each pazameter under "Quantity" and "Quality" in units specified in permit.
<br />".4reroge" is normally arithmetic average ;geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during ",1lomrnnrg Period"; "5farirnum" and "Minimunr" are nornally extreme high
<br />and low measurcmems obtained during ",tforitonng Perrod " (Note to municipals ssith sccrondar) treatment
<br />requiremenC Enter 30-day average of sample measurements under "Average," and enter maximum 7~ay average
<br />of sample measurcmcnls obtained during monitoring period under ";ilarimum. l
<br />6. Enter "Fernier Requirement" for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under ".~'o Fx" toter number of sample measurments during monitoring period Utat exceed ma.•cimum (and/or
<br />minimum or 7-day average as appropriate) purniit n;quircment (or each parameter. [f none, enter "0"
<br />8. Enter "Frequency oJAnalysis" both as ".Sample :.feosvrment" (acual frequent? of sampling and analysis used
<br />during monitoring period) and as "Fermi! Requirement" specified in per,ni[. (c.g., Enter "Coot," for continuous
<br />monitoring, "l~7" for one day per week "130"for one day per month, "I/90" for one day per quarter, etc.)
<br />9. Enter "Sample Tvpe" both as "Sample ,lfeasun~ment" (actual sample t)pc used doting monitoring period) and as
<br />"Permit Requrrernent," (e.g., Enter "Grab" for individual sample, "2dHC"' for 24-hour 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 violation by date.
<br />11. Tf "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entn'.
<br />12. Enter "Name/1'ifle njPrincipa! Executrve Officer" with "Signature ojPrincipnl Executive Officer ojAutharized
<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 far your records.
<br />14. More detailed instnrctions for use of this Discherge Monitoring Report (DtifR) 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 SIO,Q(10 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 />a
<br />EPA Form 3320-1 (Rev. 08-95)
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