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Paperwork llteduction Act Notice
<br />Public reporting burden for [his collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, tc 110 hours as as average per response for some major facilities,
<br />with a weighted average for tmjor and minor facilities of 18 hours per response, including time for revie•.ving
<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, to Chief, loforraation Policy
<br />Branch, PM-223, U.S. Eavrronmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of lnformation and Regulatory Affairs, Oflce of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />I. If form hes been partially completed by preprinting, disregard instructions directed at entry of [hat information
<br />already preprinted.
<br />2. Enter "Permittee h'ame~)ldarling Address (and facility name/ltxation, if different)," "Permit lJumber," and
<br />"Discharge Number" where indicated. (A sepazate form is required for each discharge.)
<br />3. Enter dates beginning and ending 'Alonitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample A4eawremenr" data for each paramctcr under "Quoni~ty" and "Quali!)~" in routs specified in permit.
<br />"Average" is normall} arithmetic avenge (geot.tetnc average for bacterial parameters) otall sample measluements
<br />(or each parameter obtained during ":lfonitorirg Yenod', ".t/aximurn" and "afinimum" are norudly extreme higt
<br />and loin measuremems obtained during ",afo.,ironng Period." Qdote 'o municipals tjith secondaq vcatment
<br />requirement Enter 3U~ay avenge of sample measurements under "Average," and enter maximum 7-day average
<br />of sample measurements obtained during monitoring period under ",tfaximum. ")
<br />6. Enter "Permit Requirement" for each par.,ricler under "Quantity" and "Quality" as specified in permit.
<br />7. Under ".4'o Ez" enter number of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average as aapropriate) pcriit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency oJAnalysis" both as "SmnFre ;.fea.~urneent" (adrral frequerc} of sampling and analysis used
<br />during monitoring period) and as "Permit Requirement" specified in permit. (e.g., Enter "Coot," for wnunuous
<br />monitoring, "1 c7" far one day per week, "/~30" 1'or cne day per month, "l/90" for one day per quarter, etc.)
<br />9. Enter ".Sample Type" both as ".Sample Afeasun>nrenP' (actual sample t}Pe used during monitoring period) and as
<br />"Prnnir Requirement," (e.g., Enter "Grab" for individual sample, "14NC" for 24-hour composite, "A%A" for
<br />continuous mortitanng, 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 />I1. I<"no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/Iifle oJPrincipal Executive OJTcer" with "Signature aJPrincipnl Executive Officer oJAuthorized
<br />Agent," "Telephone Number," and "Dare" at bottom of form.
<br />13. Mail signed Report to Ofi;ce(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discha"ge Monitoring Report (D1rfR) form may be obtained from OSce(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 E10,000 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 Form 3320-I (Rev. OS-95)
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