|
Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of ]0 hours as an
<br />average per response for some mirror facilities, to 110 hours as an average per response for some major facilities,
<br />with a weighted average (or major and migor Facilities of IH hours per response, including time for reviewing
<br />instructions, searching exiseing data sources, gathering and maintaining the data Deeded, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collectiom of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Env~~ronmemtal 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 "Perrhittte'Ji~airrcylNailing .4dAress (and facility namdloption, if tfigerent~~P~2i!~'siid'< '
<br />"Discharge Number" whore indicated. (A separate form is required for each discharge) - -
<br />3. Enter dates begimw.g a+~d ending "alunirorrng Period"covered by torn[ where indicated.
<br />4. Enter aadt "l'ornnerier" s ~pccilicd in monitonng requirements of permit.
<br />5. Enter ".4mnp;c a/rrc:mn er:r" dirt for each p.u:aucter under "Quontih~" and "Qualirt" in units specified in permit.
<br />",4 vr;vgr" is normally arithmeuc :rvcrage (geometric aycragc for baperial parameters) of all sample measurements
<br />for each para+a,:eer oblai ted during ".tlonil~+rur~ Prrr~J", ".tlorumm~" and ",ifuumm~+" are normally eayrerne high
<br />and Inty nte~smremeu„ obtained during ".1lonirnrrn,~ Ptr+od." (Note to municipals with secondan treatment
<br />rcyuiremcnc Cuter zn-da•. average of sample mcasurcmems under "Arerogr." and toter matimum 7~a}' average
<br />of sample measure moms obtained durinb mouitonng period under ".Lhrximum.'7
<br />6. Enter "Penrrr k+•yuvernrnP' ter each param~tcr under "i~u,rnliti'' and "QuuLn" JS specified in permit.
<br />7. Under ".'Jo L'.r" en:cr n~~mbcr of sample measuements during monitoring pcnod that exceed maumum (and/or
<br />minimum or 7-day acera;e ac ap,r•:p ate) nermi: requirement for each parameter. If none, enter "0".
<br />8. Enter "Freyu,ncy o~:lr: r/t.:r~" both as "~nnrple ,11e.~.runuenP' (actw~l frequent} of sampling and analysis used
<br />during monitoring penal) and as 'Ycruur Heyuu.oeenr" specified in permit. (e.g, Enter "Cont." Cor continuous
<br />monitoring, "l: ?" for one da} per v,eek. "! )0" for one da} per month, "1 "90" for one day per quarter, etc.)
<br />7. Enter ".Smnple T+y,~" both as ".rumple ,tle:nvrentcnr" (actual sample hpc used during monitoring period) and as
<br />"Permit Reyvireruenr," (e. g., Errcr "Groh" for individual sample, "?4H(" for 23-hour composite, ":YiA" for
<br />continuous monitonng, eic.)
<br />10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs du ' ess-form-irf~tace of data entry.
<br />12. Enter ",1'ame~Title ojPrmcipal F~~ecunve Officer" with ".S'ignature oJPrincipa! Executive Officer oJAulhorized
<br />Agent," "Telephone Number," and "Date" at bottom of torn[.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed insWC[ion; Cor use of this Dischnrge Afoniroring Repot( (DAfRI form may be obtained Gorr 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. 115.27). Failure to report or failure to report tmthfully can
<br />result im civil penalties not to exceed 510,000 per day of violatiom; or in criminal penalties not to exceed 525,000 per day
<br />of violatiom, or by imprisonment for not more than one year, or by both.
<br />EP'A Form 3320-1 (Rev. 08-95)
<br />
|