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~ Paperwork Reduction Act Notice
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<br />Pub rc rennrtmg hu rdrn Fir Fl.i~ rn!ie~tin^ nr ~nformainr. i- .:.,.. matte., .o .err '. ~.,u: a r..:ie.~ ..r iii n.,.u r: as an
<br />a...,~g~ vim, Iwpuuse :m some minor laciuues, to 1 IU Hours ets an average pet response for some major facili!ies,
<br />w!th a :vriehtr,.::.:crg., for major and mioo, fe~iliocs u( Id boors per response, includm); time for reviewing
<br />~ instructions, searching ~;ishna data sources, gathering and maintaining the dale oeedeJ. and rnmpienng and
<br />revw~wtng the collee[inr: of iaforma[ien. Send commenLS regarding the burden estimate or any nrhrr acpPcr of
<br />[tits collcclioo of inforTnatinn, including suRRrs[ions for rrducing [his burden, rn Chief, lnforrrY.tina Policy
<br />' Brarlw, P:vi-223, US. Environmental Protection Agency, 401 M Street, SW Weslungton, DC 20460; and lu the
<br />i Office of Information and Regulatory Affairs, Office of Managemom and Budget, Washington, DC 20503.
<br />General Instructions
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<br />1. If form has been partially completed by preprintioe, disregard instructions directed at entr' of tF:at information
<br />already preprinted.
<br />2. Enter 'Permiftee NnmeiAfailing Address (and facility namellocation, if differenq," "Pennir Nurnher " and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enlcr dates bcginnmg and ending 'Rlnnitnnng Penurl" covered by torn[ where indicated.
<br />.. enter ucil'T~rr,:,,n t,,".,; ,peel0ed in monitoring requirements oCpcrmit
<br />~. l.mcr '.tinmp/r irravrrmi'nt" data for each parameter under "Qunnlrty" and ";:entity" in nulls specified m porno[.
<br />".4 ~.~rrogr" is nurnla111 arithmetic aecmge (geometric alerage for bacterial parameters) of all simple measurements
<br />fa c.: it f~:uamctcr oht,lincd d~uing "l;umn>ring Prnou' , "1!r_tiimmn" and ".lfintmum" arc ..olmalh ~~treme high
<br />and loi, mcasuremculs obL'lincd during "tfonitorulg Nenud." (Note to municipals wild scconue~; treatment
<br />requirement F'nter lfl-da•~ ?vr•.~~r ~f ~..,..~.i~ mfaS::rC"r'C._~S L...~:' °'Y.';'„gC,,, and eillii i.t ,~. ~ - ~ ..1 ].iy average
<br />of sample measurements obcuncd during monitoring pcried under ",.9a:imurn. ")
<br />u. "r_nicr 'Trrmlr i<eyuue•nlenr~ iol cacti parameter under "U'+c,,Itity` and '~4)uaGn" as socclGed in permit
<br />7. Under "9'n f•~" enter number of sample mcasurmcnrs donne mommrin~ - ter.' '^at evrerd maximum (and/or
<br />minimum or 7-dav averag^_ a-~ a^propnate) pe^n•t rcquiremeat for cacti pa;..~'_tc:. 'f none, enter "(P.f'
<br />?. E-'^t^ ": •,r~y:.: n-• ,~ ,,. 'i_ ~ ~ _: •, ... ~,1•.:. 1- iWi is cyu .~} .:p: ag ays l:iw
<br />during monaaring period) and as "Peruiir:{erJuuz;Hoot" speeiaed i.. pemii ~ (c.g,~cntm "Cont."ufor continuous
<br />monitoring, ". •7" for nnc d;w per week. "/ +u" o• r - dos prr mn°: ^ ,too" for or.:. ^; ;uarter, e!c.)
<br />n r"^ '~~'^i, li'1'' T'.'~^, bJ1h ::> "r~~ii~.. .. ,,.,. ~ ~,~~liidi aulliiiii i~~~ JJtd i1611i~g h~JUdOrllik p2rIV0/ Gllll .U
<br />"Permit Rcqurremrnt," (e g., Enter "(irah" for indl~~dual rumple, "?a1fC"' fur 2d-ituur composite. ":V~.d" for
<br />cen!Inuc~JS momlcnng, e!c )
<br />10. Where violations of permit regwremenls arc reported, attach a brief explanation to desenbe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. 1f "no discharge" occurs during monitoring period, enter ",Vo Discharge" across fornl in place of data entry.
<br />12. Enter "Name'Tifle ojPrincipal Executive Dicer" with "Signature ojPrincipnl Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Of3ice(s) by date(s) specified in pert»it. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afoniroring Report (DtifR) form may be obtained From O6ice(s)
<br />specked in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.F.R. 125.27). Failure [o report or failure to report truthfully can
<br />result is civil penalties not to exceed $10,000 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.
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<br />EPA Form 3320-1 (Rev. OS-95)
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