|
Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of ]0 hours as av
<br />average per response for some minor facilities, l0 110 hours as av average per iesponse for some major Facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and vraintaiving the data needed, and completing and
<br />reviewing the collection of iv(ormalion. Send comments regarding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, to Chief, Infortna[iov Folic}'
<br />Branch, pM-223, L.S. Evvirovmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to thz
<br />Office o(lnforma[iun and Regulatory Affairs, Office of Alanagemen[ and Budget, 1~ashingtov, DC 20503.
<br />General Instructions
<br />1. If forpt has been partially completed by preprinting, disregard instructions directed a[ entry of that information
<br />already preprinted.
<br />2. Enter 'Permitter R'ame/ltfading Address (and facility name location, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending "Afonitoring Period" coy eyed by form where indicated.
<br />4. Enter each "Parameter" as specified in moniteing requircrnetus of permit.
<br />S. Enter ".Sample ,ifeasurement" data far each p:uamelcr under "Quontiry" and "Quality" in units specited in permit.
<br />"Average" is nonnaliv arithmetic average (geometric average for bacterial parameters) of all simple measurenteats
<br />for cagh parameter obtained during "Alnnitor;ag Fermd"; ".6laxunum" aad "A:inimunr" arc normally extreme high
<br />and Iqw measure racnts obtained during ".lGmituring Perrad." QVote to municipals with secondar} treaL•nenl.
<br />requirement Enlcr 30~a}' average of sample measurements under "average,' and enter maeim~m 7d:,y avemgc
<br />oC sample measurements obtained during monitoring period wider ".tlaximum. "/
<br />6. Enter 'I Pennir Rcuuiremen!" for each parameter under "Qunntiry" and "Qualitl•" as specified in permit.
<br />7. Under ~"No Er" enter number of sample maisurnten[s during monitoring period that ewnxd maximum (and/or
<br />minimum or 7-dav average as appropriate) pecnit requirement for each parameter. !f none, enter "D".
<br />8. Enter 'Frequency ojAnalysis" both as "Sample Afeasurment" (actual :rcquenc}' of sampling and analysis used
<br />during monitoring period) and as "Fermi! Re7uiremenP' specified in permit. (e.g., Enter "Coot," for continuous
<br />monitoring, "1/T' for one day per week, "1/30" for one day per month, "//90" for one day per quarter, etc.)
<br />9. Enter "Sample Ttpe" both as "Sample bfeasu, ement" (actual sample t}•pe used durng monitoring period) and as
<br />"Fermi! Requirement," (e.g., Enter "Grab" for individual sample, "2dNC" (or 24-hour composite, ".V/A" for
<br />continuous monitoring, etc.)
<br />10. Where Iwiolauons of permit requirements are reported, attach a brief explanation to describe cause and cortective
<br />acuons',taken, and reference each violation by date.
<br />I1. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name.Title oJPrincipa! Fecutive O~cer" with "Signature ojPrincipa! Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Date" at bottom of (orm.
<br />l3. Mail signed Report to Office(s) by date(s) specitied in permit. Retain rnpy Car your records.
<br />14. More dretailed instructions for use of this Discharge Afonitoring Report (D,19RJ forth may be obtained Crom OHice(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is kequired 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 Ienalties not to exceed 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 ono year, or by both.
<br />EPA Form 3320-1 (Rev. 08-95)
<br />
|