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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of informatioq is estimated•~p".y_ from a range of t0 hours as an
<br />average per response for some minor facilities, to 110 hours as an average ~' nse for some major facilities,
<br />with a weighted average for major and minor facilities of IS hours per re nse, including time For reviewing
<br />instructions, searching existing data sources,' `dg awd tgaigtaining the aatz needed, and completiq
<br />reviewing the collection of inForrnation. Send'" nts regarding the burden estimate or any other of
<br />this wllection of informatioq, including sugges "for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Eoviroamental Protection Agency. x!01 i/ Street, SW Washington~DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of ,Vianagement and Budget, Vl/~iilj~oq, DC 20503.
<br />general Instructions
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<br />I. If form has been partially completed by preprinting, disregard instructions directed at entry of that informap~`c
<br />already preprinted. ~"~
<br />2. Enter 'Permi((ee Name/bfai/ing Address (and facility namellocation, if different)," "Permit' Number," and
<br />"Discharge Nurnber" where i (~ separate form is required for each discharge.) -
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<br />3. Enter dates beginning and ewli6g 'Afonimnng Period"covered by form where indicated.
<br />4. Enter each "Parameter",aS specified in monitoring requirements of permit
<br />5. Enter "Sample hfeasurement" data for each parameter under "Quantity" and "Quali(v" in units specse~ta permit.
<br />"Average" is normally aritlime;ic average (geometric average for bacterial parameters) of all sample measurements
<br />far each parameter obtained during "Monitoring Period"; "Maximum" and "hfinhnu,n" are normally extreme high
<br />and low meastuements obtained during ".tonitoring Period." (Note to municipals ~.vith secondary treatment
<br />requirement Enter 30-dap average of sample measurements under "Average," and enter tnaximum 7.d~' average
<br />of sample me3strremen's obtained during monitoring period under "A-larimum.
<br />6. Enter "Permit Requirement' for cacti pamme[er under "Quantity" and "Quality" as specified in permit
<br />7. Under "No E:x" enter nurnbcr of santplc measuements during monitoring period that :xceed maximum (and/or
<br />minimum or 7-day average as appropriate) pertttit requirement for each parameter. If none, enter "0". ;
<br />8. Enter "Frequency r;f Ano:ysis" both as "Sample hlensurmenP' (actual frequency of sampling and analysis used
<br />during monitoring period) and as "Per,ui( Requirement' specified in permit (e.g.. Ewer "Coot," for continuous
<br />monitoring, "1/7" for one clay per week, "1,30" for one day per month, "1/90" For one day per quarter, etc.)
<br />9. Enter ':Semple Tvpe" both as "Sample Aleasuremenr" (actual sample 4'Pe used during monitoring period) and as
<br />"Permit Requiremerr," (e g., Enter "Grab" for individual sample, "2dHC" for 23-hour composite, "N/.a" for
<br />continuous monitoring, etc.)
<br />I0. Where violations of perm t requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each v~clation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data envy.
<br />12. Enter ",b'ameiTitle ojPrincipa! Executive Officer" with "Signature ojPrincipal Executive Officer oJAufhori~ed
<br />Agent," 'Telephone .'Number," and "Date" a[ bottom of (orm.
<br />13. Mail signed Repott to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge MonitorinARepori (DAfR) form may be obtained Irom OtFce(s)
<br />specified in permit.
<br />Legal Notice
<br />"['his report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to report or failure to report truthful:y can
<br />result in civil penalties riot to exceed $10,000 per day of violation; or in criminal penalties not to exceed 525,000 per day
<br />of violation, m by impnsonment for not more than one year, or by both.
<br />EPA Form 3320-1 ;Rev, OS-95)
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