|
Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary (ram 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 major facilities, ~
<br />with a wej hied avers a for tna or and minor facilities of 18 hours ~
<br />g g J per respoose, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and ~
<br />~ reviewing [hi collectioo of information. Send cammenU regarding the burden estimate or any other aspect of ~
<br />' this collection of information, including suggestions for reduciag this burden, to Chief, Information Policy j
<br />Branch, PM-223, U.S. Environmental Protzction Agency, 401 M Streit, 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 przprinting, disregard instructions directed a[ entry of that informatioo
<br />already przprinted.
<br />2. Enter 'Permiltee .Name%,4faifing Address (and facility name location, if different)," "Perini( Number," and
<br />"Discharge .h'umbr•r" where indicated. (A separate fornt is required for each dschazge.)
<br />3. Enter dates beginning and ending ".lfonitonng Period" covered by form H here indicated.
<br />4. Enter each "Parurneter" as specified in monitoring requirements of permit.
<br />5. Enter ",Sample ,Aleasvrement" data for each parameter under "Quantity" end "QuoliN" in units specified in penni[.
<br />"Average" is norntalh arithntelic average (gzometric acem~c for bacterial parameters) of aJl sample meastrements
<br />for each parameter obtained during ".tlonrtori,,g Pern,rP'; ",1laxrmwn" ar.d ".Ninimwn" are nonnillp extreme high
<br />and low mcasurcwcnts obtained during ':tlr.ajtcring Period" (Note [o municipals v,iih secondary treatment
<br />requiretnenr Enter 311-day arcrage of ,ample mea_stuemcnts under "~1ve~age," and enter maximcm 7-0a} avemge
<br />of sample meastuemenis obtained during mouitoring period under':tfaxin~um.
<br />6. Enter "~errnit Requirement" for each parameter under "QuanljN" and "Quality" as specified in pznnil.
<br />7. Under P,No Fx" enter number of sample measurments during monitoring period that ext:eed maximum (and/or
<br />mmimtlm or 7-da~ average as appropriate) pcnnit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency ajAnalysis" both as "Sam,~le .4leasurnn=nt" (actual frequcnq oC sampling and analysis used
<br />during monitoring period) and as "Fermi! ReruiremenP' specified in permit. (e.g., Enter "Coot," for continuous
<br />monitorng, "l~T' for one day per week, "/~30" :or one day per month, "1/90" for one day per quarter, etc.)
<br />9. Enter "Sample Type" both as "Sample .47eosurement" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" f'or individual sample, "2JflC"' for 2~3-hotu composite, "N'/A" for
<br />continuous monitoring, 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 />11. U "no tscharge" occurs during monitoring period, enter "h'o Discharge" across form in place of data entry.
<br />12. Enter "Name//'itle ojPrincipal Executive OJ7cer" with "Srgnature ojPrincipal Executive OJTcer ojAuthnrized
<br />Agent," "Telephone Number," and "Date" at bottom o(form.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More dbtailed instructions for use of this Discharge rLlonitoring Repot! (D,11R) form may be obtained from OBice(s)
<br />spec~ep 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 ¢enslties not to exceed E10,000 per day of violation; or in criminal penalties not to exceed $25,[)00 per day
<br />of violation, o~Ir by imprisonment for not more than one year, or by both.
<br />EPA Fotm 3 1330-1 (Rev. 08-95)
<br />
<br />
|