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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated [o very from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per response for some rmjor facilities,
<br />with a weighted average for major and minor facilities of IS hours per response, including time for reviewing
<br />instructions, searching exis.iHg data sources, gathering and maintaining the data Headed, and completing and
<br />reviewing the collection of information. SeHd comments regarding [he burden estimate or any other aspect of
<br />this collection of inforrnatien, including suggestions for reducing this burden, to Chief, InformatioH Policy
<br />Branch, PM-223, U.S. Env ronm,:Htal ProtectioH Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of InformatioH and R~gula[ory Affairs, Office of Management and Budge[, WashrngloH, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that informatioH
<br />already preprinted.
<br />2. Enter 'Pennrt(ee ^'c.rr..l:o:Gng Address (and facdiry name/!e~uon, rr d~trrrenq," "Permit rVumher," and
<br />"Drschnrge A'umher" where indicated (A separate (arm is required for each discharge )
<br />3. En er d lcs bcginning.~~d end ng ".l(nnrtoring Period"cocetcd by form nhcrc indicated.
<br />4. Et:rer tacit "Pm'n:.:c rei' ;:c ;pe_ificd in monitoring rquiremcnts of permit.
<br />5. 3c,cr "7c.,rple 11: ~esurr,r nl" daa far each parameter under "{hunhty" and "Quality" in units specified in permit.
<br />". Ire!rner" is nurnr!!/ c. ~'hmcr•c average (gconstric n~crae,c fur bactcnal ptu Wnctcrs) of ili! sample measurement;
<br />for each parameter obta,ner; d.•r~-o ":.fnnihvn,g 1'erlnrf, ".l(cr:m«nr" and ",L'inu,rum." arc n~rmall} e~trcmc high
<br />and lor+~ ute,uurcrr.r.'s cbtni.,cd during ':'Jnnr(rv~i+r~ Pennd" (Note to m~sticipals with sceendan tr~ealmcnt
<br />rcyuiremenC En!_r ;0-r.~.l as~crage of vntpte mcastirenicr.ts urdc; ~,Icerc~,~e," sad enter :navmurn 7~::y aseragc
<br />oC~lmple mcasa~_msnis Hbk:ir,cd ~orttg ntanitnrmg period under ".+.faz~mnm.'J
<br />6. Eraer "Permu!:,:,r~r~u:, .v' rpr cad, parameter undCr'Quauli(r' and "Quo!:,y' :u specified in permit.
<br />'. under ".Vo I--~" crt.:r number of s:a,i71c mcasurntcnts dcrin~ monitoring xrs= Ihar exceed maumum (andbr
<br />minimum or 7 day as cra;c ~ :p,rroprtate) pcrrnit rgmrement for cech parartrtcr. !f none, enter "%/"
<br />S. Enter "Frequenn oj:lnc!y`is" both as "Sm+;p!e .ll:•as«rorenP' (actual Crcquenc3 of sampling and analysis used
<br />during monitcriny period) and as "I'rrmir Kequirenrerr(" specified in permit. (e.g.. Enter "C'onr," for conunuous
<br />moniioring, "1%7" far one dad per week. "!NO" for one day per month, "I%90" for one day per quarter, etc.)
<br />9. Enter "S'mnple Type" bosh as "Sample aleosuremen(" (actual sample qpc used during monitoring period) and as
<br />';°ermrt Requrrenrent," ;c. g., Enter "(irah" for indnddval sample, "TaH("' for 24-hater cornposile, ",\'.;4" for
<br />conunuous monitoring, etc.)
<br />10. Where ciolauons of permit requirements arc reported, attach a brief eeplanatien [H desenbe cause and corrective
<br />actions taken, and reference each s~olation by date.
<br />1 I. U "no dtscharge" occurs during monitoring period, enter ".1'o Discharge" across form in place of data entry.
<br />12. Enter ",lrame.~Ti(!e ajPrincipo! Executive Officer" uilh "Signa(ure ojPrincipo! Exec+rlive O~c,-r ojAulharized
<br />Agen(," "Telephone h'um5er," and "Dare" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in pernti[. Retain copy for your records.
<br />I4. More detailed instructions Cor use of this Discharge Monitoring Report (DrlfR) form may be obtained from O13ice(s)
<br />specified in permit.
<br />Legal Notice
<br />T7tis report is enquired by law i 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 erceed 510,000 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 />E.PA Form 3320-1 (Rev. 08-95)
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