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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated vary from a range of 10 gouts as an
<br />average per response for some minor facilities, to 110 hours as as averag 'response for some major facilities,
<br />with a weighted average for .aajor and minor facilities .of j8 Lours per response, including time For rviewing
<br />mSINCtlOdS, searching existu,g data sources, ~r~rering-and'mrfiintaining tie data :,ceded, and completing and
<br />reviewing the collection of information. Send coipments regarding the burden estimate or any other aspect of
<br />this collection of information, inc;uding suggestions for reducing this burden, to Chief, information Policy
<br />Branch, PM-223, U.S. Envirurunental Protection Agency, 401 iv, Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of i[5anagement and Budget, Washington, DC 20503. _
<br />general Instructions
<br />1. If form Lss been partially completed by preprinting, disregard instructions directed et entry of that information
<br />already preprinted.
<br />2. Enter 'Permittee Name/hfailing Address (and facility namellocation, 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 'Monitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter "Sample hleasureme,tt" data Cor each parameter under "Quontity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obtained during "Aonitoring Period"; "Alazimunr" and "Mininrunr" are normally extreme high
<br />and low measurements ot~tained during "hfonitoring Period." (Note to municipals taith secondary. treatment
<br />requirement: Enter 30-day avetage of sample measurements under "average," and enter maximum i~ay average
<br />of sample measurements obtained during monitoring period under "fvla;imum.
<br />6. Enter "Pennit Reguiremerrt ~ for each parameter under "Quantity" and "Quality" as specified in permit.
<br />7. Under "Na Ez" entc[ nurrber of sample measurmenu during monitoring period that exceed maximum (and/or
<br />minimum or 7-0ay average as appropriate) permit requirement for each parameter. tf none, enter "0".
<br />8. Enter "Frequency ojanal.sis" both as "Sample .~LleasurmenP' (actual frequenry of sampling and analysis used
<br />during monitoring period) and as "Permit Requirenrenr" specified in pem»t. (e. g., .°.nter "Conn," for continuous
<br />monitoring, "l/7" for one nay per week, "I~30" for one day per month, "//90" for one day per quarter, etc.)
<br />9. Enter "Sample Tvpe" ~offi as "Sample MeasuremenP' (actual sample type used during monitoring period) and as
<br />"Permit Requrremenl," (e.g., Enter "Grab" for individual sample, "2~lffC"' for 24-hour composite, "N/.4" for
<br />continuous monitoring, etc.l
<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. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />l2. Enter "Nnme//'itle oJPrincipal Executive Officer" Hith "Signature ojPrincipal Executrve O~cer oj.4uihorized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />] 3. Mail signed Report to t~ce(s) by date(s) specified in permit Retain copy for your records.
<br />I4. More detailed instructions for use of this Discharge hfonitoring Report (D.t.IR) form may be obtained from f)~ce(s)
<br />specified in pemtit.
<br />Legal Notice
<br />"['his :epor. is ,eq.iired 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 xl ro exceed "y 10,000 per day of violation; or in criminal penalties no[ [o exceed $25,000 per day
<br />of violation, or by imprseneneni fx not more than one year, or by both.
<br />F.2A Fora. 3320-1 (Rc:~. i~E-95}
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