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Paperwork Reduction Act Notice
<br />I fbblic repofwg uw den fui LLia wlleciiun of in formx[ion is estimated to vary teem ~•. rt~:;^ et IC hour. a. a.,
<br />~ average per response for some minor facilities, to 110 hours as an average per response 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 maintaining [he data neea!ed, and completing sad
<br />reviewing the collection of information. Send comments regarding the burden estimate or any ether aspx; of
<br />this collection of information, including suggestions for reducing this burden, to Chief, lufmuutiuo Fnlicy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Infurmatioo 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 directtd at entry u( Wal infurmation
<br />already preprinted. _
<br />2. Enter 'Permitfee Nanre%i4oifing Address (and facility namellocation, if ditt'erenl)," "Permit '/rnrnber," and
<br />"Ui.ccharge Number" where indicated. (A separate form is required for tack discharge.)
<br />3. Enter dates beginning and coding "Afatitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enicr "Sample ,Measurement" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average (geometric average Car bacterial pammctcrs) of all sample measurements
<br />for each parameter obtained during ".LJoniloring t^eriud", "Afazimum" attd "~Vimmum" are normally extreme high
<br />and low measurements obtained during "Monirurmg Period." (Note to municipals t+~th secondary treatment
<br />requirement. Eater 1^-day average o; saniplc measurement under "Averose," ;,.r.d enter ntadmum 7-0ay a+•crage
<br />of sample measurements obtained during monitoring period under "Maximum.')
<br />6. Enter "Permit Reguiremenl" (or each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under ",h'o E:" enter nur.:lxr of wimple me:.surmenu during monitoring period that e:tcced. sraimum (and/or
<br />minimum or 7-day avemge as appropriate) permit requirement for each parameter. If none, enter "0".
<br />8. Enter "Frequency oJ.lraly.ris" bot;~ a; "Suinpir nieueurneni" (aciual Gcyueu~y of sampling and analysis used
<br />during monitoring period) and as "Permit Reguiremenl" specified in permit. (e.g., Enter "Cant," J'or continuous
<br />monitoring, "I/7" for ore day per tvsl., "1'30" for cnc day per mo;;tlt, "I t90" for c„cWny per quarter, r.ie.)
<br />9. Enicr "Saample Type" bath as "J'ample Afeat7vemenP' (actual sample type used during monitoring period) ar.d as
<br />"Fennit Requrrement," (c g., Enter "C~rnh" for individual sample, '7x11("' for 24-hour contposilc. "N/.4" for
<br />t:onlinuotu monitoring, etc.)
<br />10. Where violations of permit requirements are reported, a1L'tch a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />1 I. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />]2. Enter "Name/title ojPrincipal Fsecutive OjTcer" with "Signature ojPrincipa! Executive Officer ojAvthorized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to 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 (DhfRJ form ma} be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This repoR is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure to repoR or failure to repoR truthfully can
<br />result in civil penalties not to exceed 510,000 per day of violation; or in crirninal penalties not to exceed x25,000 per day'
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
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