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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a ranee of 10 hr.r~rc as ~.
<br />o"c~go_ rc: ,ecruuc- fur eum_ uLr:ur fcciliiiw., io 110 bourn r~ ca evua:go j.a .-spas.: io: ;.,,,,u wc~u, iaciiiiies,
<br />with a weigbied average for major and minor facilities of 18 hours per response, indudine first for rertwing
<br />instructions, searching existing data sources, gathering and maintaining [he data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />~5 uolleciion of information, including suggestions for rrducimg [his burden, to Chief, loformalioo Policy
<br />tlr2nch, Pt:1-Z23, U.S. Em~ironmental Protection Agcmcy, 401 M S[rca, SV! WashL;gWn, DC 204u0; and io 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 preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter "Permiltee Name/Mailing Address (and facility Itamelloeatiom, if diBerent)," "Fermi! Nwnber," and
<br />"Dischaargr ,Number" where indicated. (A separate form is required for each discharge) "
<br />3. Suter daies beginning and ending "Afnnitoring Period" covered by form where indicated.
<br />4. Enter each "Poramrrer" as specified m monitoring requirements of permit.
<br />;. Enter "So;uple ,:feast; emn;P' data fvr acli parameter under "Quantity" arrd "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average (geometric average far bacterial parameters) of all sample measurements
<br />for each parameter obtained d±~rino ".4faniloring Period'; ".4faximum" and "Minirnum" are normall}' exVeme high
<br />and low measurements obtained during ".lfonit~ring Period." (Note to municipals with secondary treatment
<br />requirement: Enter 30-day average oC sample measurements under "Average," and enter maximum 7-0ay average
<br />of sample measurements obtained during monitoring period under "Afazimum.
<br />5. Enter "Permit Rcguircmrnt" for c~ch parameter under "Qunrri ~•" arrd "Quality" as specified in paT„Ii.
<br />7. Under "No Fes" enter number of sample measurments during monitoring period that exceed m,~ximum (and/or
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. If none, enter "0".
<br />k toter "Hrenovnry n1 4nnh,crr" hnth ac "\mnntr A4anc~rmanl" (artnal Irrmicnrv of ,Lmm~lmo vnrl anaiacrc Used
<br />during monitoring period) and as "Perntil Requirement" specified in permit. (e.g., Enter "C'ont," for continuous
<br />monitoring, "I/7" for one day per week, "1/30" for one day per month, "1/90" for one day per quarter, etc.)
<br />9. F.n1er "Smm~la TVnv" hmh as °•Cmm~le 14ancurrmanP' (arhial sample type psrA rhirinv monitoring r~prinrll port pe
<br />"Fermi( Requirement," (c.g., Enter "(7rab" for individual sample, "?•lI1C" fur 24-how composite, ",~'/A" fo.
<br />continuous monrtoring, etc.)
<br />10. Where violations of permit requirements arc reported, attach a brief explanation to describe cause and coredive
<br />actions taken, and reference each violation by dale.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across fornt to place of data entry.
<br />12. Enter "Name/Title ojPrincipal Executive Officer" with "Signature ojPrincipa! Executive OfJ7cer ojAulhorized
<br />Agent," "Telephone Arumber," and "Dale" at bottom of form.
<br />13. Mail signed Report [o Office(s) by date(s) specified in perntit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (DAIR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />71;is 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 penalties not to exceed 510,000 per day of violation; or im 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 />EPA Form 3320-1 (Rev. 08-95)
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