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Paperwork Reduction Act Notice
<br />~ .. ~•hlic rcpriiir,g `,urd?r~ for this cullccliuu of infun.wiiuu is esli marul rn varv from a rangy? ,.r 10 h;;urs as ar.
<br />average per response for some minor facilities, to 110 hours es an average per response for some major facilities, '
<br />with a weighted average for major and rmnor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gxlhering and marntainiog the data neerlert, "mJ completing and '
<br />reviewing the collection of information. Send comments regarding the burden estimate nr any nrhr. asrect of
<br />this collection of information, including snooestioos for reducing [his burden, to Chief, Infc ~a;ion Policy ~
<br />Branch, PM-223, U.S. Environmental Prolusion Agency, 401 M Street, SW Washington, DC 20460; and to the j
<br />~ Office of Informatiuu and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. ~~
<br />General Instructions
<br />I. If form has been partially cmm~lrrNwa by preprnting, disregard instrsaicns dire.:F,;.a a. ...,try ~f J~at info~ra .;~uu
<br />already preprinted.
<br />2. Enter 'Pcrmittce A'nnre.:lloilinR Address (and facility nante/location. if differenrt." "Pvrrnir Nv.nr~.~r." a~n
<br />"Dn\rhnrge ~Yunbrr" inhere indicated (A separate Corm is required for each discharge.)
<br />3. Enter dates bcginnmg and rnding ".5faiitunnk Period" covered by form where uidicaled.
<br />4. Enter each "l'arametcr" as spcnlicd in monitoring requirements of permit
<br />5. Enter ".1'nmple ,4fensuremenP' data for each parameter uuder "Quunlity" and "Quality" in units specified in permit.
<br />":L ernge" is norntally arithmetic average (geometric average for baclenal parameters) of all sample measurements
<br />for each parantcler obtained during ".11.rnilorml; Period"; "4lazuruun" and "dlrnimunr" arc normah extreme high
<br />and low measurements obtained during ".llonuurrgq Period." (Note to municipals \s:th eso°aty treatment
<br />requitement Enter '0-da. ,ivuag~ .d :.rm~lc +n~.i~wciuruls wider "average," and enter n~..: ~~ .la 7~ay a\~cragc
<br />of sample measurements obtained during monitoring per iud under ".llarimum.)
<br />6. Enter "Permit Kegmrement" for each parameter uodrr "Ounn(irti' end "Quality" as spe^Se_' ~r permit.
<br />7. I!nder ".No Er' enter number of samp!e r.:wsu^.::e^.L durit:g :re::itu^ng perod t?'.a c...:.ed-m9ximtun (and/or
<br />minimum or 7-day a\eragc as appruprialc) perniit rcquucmcm for each parameter. If none, enter "0"
<br />~. Eh,.. ..urui nc~ Of nnm'L-~IJ ~~ bJih iu' '. iiiipic ..iCU.iui uiiiu (aC.iini ii Cyui.~:~-j Ot iariiNi,iis ~;iu' anaiy5i5 udru
<br />during monitoring penod)~and as "Permit Regmrcuu•n1" specified in pcrmrt. (e g., Enter "Conn," for continuous
<br />mon!lonng, '!'7" ter one d:.y per w:cl:, "1 ?!'" for,..,: ~''.~ pc. rag :;::. '; ''7" . _..,..e day per qc .._ , . \
<br />9. Enter ".Sample Tvpe" bosh as ".\'amp(e .t/rn.curemvnr' (acnial sample ppc peen during momtonng period) and as
<br />"Permit Regmrement," (e g., Enter "flrah" (or individual sample, "?JI/C"' for 24-hour compushc, "~ :4" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements arc reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by dart.
<br />11. U "no discharge" occurs during monitoring period, enter "h'a Discharge" across form in place of data entry.
<br />12. Enter "Name/l'itle ojPrincipal Executive Officer" with "Sij;nature ojPrincipal Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Dale" at bottom of tarns.
<br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afonitoring Report (Dh1R) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />'ibis 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 in 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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