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Paperwork Reduction Act Notice
<br />Public reporting burdee for this collection of information is estimated to vary from a range of 10 hours as an
<br />average per response for some minor facilities, l0 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and ntinor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching ezis.ing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of mfotTnation. Send comments regarding the burden estimate or any other aspect of
<br />this collection of information, urcluding suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agenc}, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of A9anagement and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. if form has been partially completed by preprinting, disregard instructions directed at eotry of that information
<br />,_.. -_alrea~y.preprinted.
<br />2. Enter 'Permutee ,\'anre~.tfoding Address (and facility ttameAocation, if different)," "Permit .Number," and
<br />"Dscharge Number" where indicated. (A separate (orm is required (or each discharge.)
<br />3. Enter dates beginning and ending ';tfonrtnring Period" covered by form where indicated.
<br />4. Enter each "Pnrometer" rs specified in monitoring requirements of permit.
<br />5. Enter "J'onrple Alensuremenr" data for each parameter under "Q,wnttrv" and "Uuahty" in units specified in permit.
<br />",-1 verage" is normaly arithnteir avemge (geometric average for bac(erial parameters) of all sample measurements
<br />for each parameter obtai ied daring ";[fonimring Period"; "6lazvmum" and "Alininuun" are normally e~lrcme high
<br />attd low measurements obtained during ",Lfonimrirrg Periud." (Note to municipals wi(h secondan treatment
<br />requirement: Enter 30-day ::v~•ragc of sample measurements under ".4rerage," and enter maximum 7-day average
<br />of sample mcasureroents ~btamcd during monitonng period under "9fanmum.')
<br />6. Enter "Permit Requirement" for each parameter under "Quantity" and "Quulr(v" as specified in permit.
<br />7. Under ".No Ex" inter m.~mbcr of sample measurments during monitoring period that exceed maximum (and/or
<br />minimum or 7-day avemge as appropriate) permit requirement Cor each parateter. If none, enter "0".
<br />8. Enter "Frequency nj.an,n;as" both as ".Sample Afeu.curment" (actual frequency of sampling and analysis used
<br />during monitoring penal) and'. as "Penrrir Requtrenu•nt" specified in pernul. (e g., Enter "Coot," for continuous
<br />monitoring, "N~" for one day per week. "t 30" for one day per month, "I '90" for one day per quarter, etc.)
<br />9. Enter ".Sample Trpe" both as "Sample ,tfeosumment" (actual sample t}pe used during monitoring period) and as
<br />"Permit Requirernenr," (e.g, Enter "Grab" for inditedual sample, "24H~" for 24-hour composite, ",V'.4" for
<br />continuous monitoring, eic.)
<br />I0. Where ~~olations 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 />12. Enter "Name/I'itle ojPrmcipa! Executive Officer" with "S'ignature ojPrtncipa! Executive Officer oj.4uthorized
<br />Agent," "Telephone Numl,er," and "Date" at bottom of form.
<br />13. Mail signed Report to OOice(s) by date(s) specsed in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afoniroring Report (DbfR) form ma}• be obtained from l?6ce(s)
<br />specified 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 penalties not to ezcced 510,000 per day of violation; or in criminal penalties not to exceed E25,000 per day
<br />of violation, or by imprisonment for not amore than one year, or by both.
<br />EF'A Form 3320-1 (Rev. OS-95)
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