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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection 'of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, to 110 hours as an average per msponse for some major facilities,
<br />with a weighted averege for major and minor facilities bf 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gatherine 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, includi.,k suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Envirorsaeotal Protection Agency, 401 M Street, SW V/eshington, DC 20460; and to the
<br />Office of Information and Regt:latory Affairs, Office of Management and Budget, ~*/ashington, DC 20503.
<br />General Instructions
<br />6.,.
<br />1, If form has bcen partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2, Eater 'Permittee Name/Mailing Address (and Caciliry nameJlocation, if different)," "Permit Number," and _
<br />"Discharge Number" where indicated. (A separate form is regttiGed for~ach discharge.) '
<br />3. Enter dates beginning and ending 'iLfoniroring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample Mensuremerr" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during "A~foniloring Period ; "Adaximum" and "Minimum" are normally extreme high
<br />and low measurements obtained during "hfoniroring Period." (Note to municipals with secondary Veatrnent
<br />requirement: Enter %0-day average of sample measurements tinder "Average," and enter maximum 7-0ay average
<br />of sample measurements obtained dtuing monitoring period under ",tlaximum.'J
<br />6. Enter "Permit Requirement' for each parameter under "Quantity" and "Quality" as specSed in permit.
<br />7. Under "No Ez" enter number of sample measurtncnts during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. L`none, enter "0".
<br />8. Enter "Frequency ojAnal~sis" both as "Smnple ~tleasurment" (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Pemeir Requirement" specified in permit (e.g., Enter "Coot," for continuous
<br />monitoring, "1/7" for one nay per week, "1 i30" for one day per month, "//90" for one day per quarter, etc.)
<br />9. Enter ".Camp/z Ttpe" both as "Sample Afeasuremer.•7" (actual sample type used during monitoring period) and as
<br />"Pern»r Requirement," (e.g., Enter "Grab" for individual sample, "2dHC" for 24-hour composite, "N/A" for
<br />continuous monitoring, etc.)
<br />10. LVhere violations of ncrmi requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions takep, and reference each violation by dale.
<br />11. ff"no discharge" occurs during monitoring period, enter "h'o Discharge" across farm in place of data entry.
<br />12. Enter "Name/fide ofprinripnl Executive Officer" With "Signature oJPrincipal Executive OjficerojAutho,ized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report [o Office(s) by date(s) specified iu permit. Retain copy for your records.
<br />}4. More detailed instnrctions for use of this Discharge Afoniloring Report (DAfRJ form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />'I'bis report is squired by law (33 U.S.C. 1318; 40 C.F.R. 1?5.27). Failure to report or failure to report truthfuC j can
<br />result in civil penalties not to excxd S 10,000 per day of violation; or m criminal penalties not to exceed $25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Fot~rt 3320-1 (Rev. OtJ-95)
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