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Paperwork Reduction Act Notice
<br />_ ._~......._. ...~... :.:• .::., tuu _L:._:, ~.:: ::i ~..il i(_r.a ,: :: .: J.i:aA:,.J ... ..ll. i:,::u .. rant. ..t II: bi.n(S a5 E.,
<br />SVera~e per rGSpOU tic IOi RUme minnr taClhtle5, t0 110 boars as an aver8se per 25nnnCe fnr .cnmr maim faC111 t1eS,
<br />wdh a w~tghtw average fur major and minor iactiitics of t8 hours per response, including time for reviewing I
<br />~nslruc[ious, searching ~x i.sting data sources, kalherinx and mninlaininY the data neeried, and r,,rmplrt;ng and ,
<br />reviewing the wlleaiun of mfsmation. Swd comments rey!ardine the burden eaimate ur any Ottirr_.pwt of
<br />i this collection of information, meludine sugnecmnne fnr r,rlprino this burden, to Chief, Information Policy
<br />nranch, Yivi-[l3, U.ti. Envtroomental protection Agency, 401 M Street, SW Washington, DC 20~i60; and to the
<br />Offix of lnfurrnatinn and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />General Instructions
<br />1. If form has been partially wmpleled by nrenrinting, disregard instructions directed at entry : f that inf,:,-,wG~~
<br />already preprinted.
<br />2. Enter 'Penm!!er 1'nnre .4lailing Address (and facility ttame/Iocati0n, if differenll." "Pervnir ,Vrnnhar." and
<br />uic:imrga .tiurnin•r" „here indicated. (A separate form is required for each discharge.]
<br />"t. i~ n',rr n.,res bign:mep, ::nd ending ".1 Jum:nrur,~ :'errod" covered by form where indicated.
<br />3 i:nicr ::; ~_i: !'uru.orr::~r as spccdica :a r,:u:atonnk rcgmrements of permit.
<br />5. Enter "`'ample !,'::-., r^r. •; n" date frr c~;rh parameter under "Quanriry" artd "Quality" in units specitlcd m permit.
<br />".1., ~~F." i; ~:onuil~, arihwcuc a,cra;;c (g.:omctnc a,crage for bacterial parameters) of all sample measurements
<br />rot r:.^^ p~rama:r a^'~men dunce :'.lor.r!:.r,r~ 1'trrur:', "t&uumun" and "A~~mmm~r" urc aur:;!'lly extreme high
<br />and low nldliuiC,.:,:uis obtaured dunng "t/orrirtrrurX Perrocl." (1Jote to municipals mih c_condary treatment
<br />~^ in '~ ~' ..;iSu:ini~JiS m~3~+ average," and ar ~ .um 7-da} a4 cfagc
<br />of sample mc~surcn:cnts obta:ncd~during memtorinh period under ".t lasimum.
<br />6. Enter '74•rour Rcyuu~rmenr" for each oaramacr under "r hmnun"and "Qunlnr' ~ts sprr•ili~d in pernnt.
<br />7. Under ".Nn Hx" enter mimhrr nr camper mr~a_ir~n?ntc ,t:~!;ng n4oni!orine perdo:' :.`~t exceed Inaxirtam (and,'or
<br />minimum or'.-da; a4 tragc d approprat~l p~r~:it ~Cyuircw~ui fur Inch paramc;c-. 'f uuuc, enter 0".
<br />_. Frrqu: rcy ~)~ ^~i urs' ,:a: _ ..;:r,;p;. ..:. :, t° al :,.;yu :.:'~ sacnptn.b and analysis usCd
<br />during monitoring pcriud)~and :u "Permr! Rcrymrcrncnr` spccificd~in pcrnut ~~(cgV,Entcr "Coot," for continuous
<br />monitonng. "1'T' fnr one de}' p,:r p,,,_L.. "/ :n^ h., r•._ ,t ~ per ...nil; :.1 -qn•' fe- ...~ ~+'~y per q::..... c!c )
<br />9. Euier "Swnple 7~pr" barb as "fimnpir .',iemarrna'n(` urcluai +:uupir type usc,i unnng uiouiioni.'~ pcnuui ~:nd as
<br />"Permit Regvirenamr." fag., Enter "Groh" for indn'idual sample. "?dllt"' for 24-hour eompasuc, ".~'.~:4" for
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requiremems arc reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. U "no discharge" occurs during monitoring period, toter ":Vu Discharge" across form in place of data entry.
<br />l2. Enter "Name/1'itle ojPrincipal Executive Officer" with "Signature oJPrrncipnl Executive OJTcer oJAuthorized
<br />Agent," "Telephone Number," and "Dale" al boltortt of form.
<br />l3. 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 (DhIR) forth may be obtained from Office(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 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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