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Paperwork Reduction Act Notice <br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as m <br />average per testa mse fur •:ome mina: fa:,htir~, ~:~ i ~:; +.n~~• ::-,~ ,;,: s. ~,.3:~e tier response (nr ., :,nr major .facliiie~, <br />' with a weighted average for major and minor facilities of 1B Sours per *cspome, including time for reviewing <br />instructions, searcbtnK existing data sources, Kethenug and maintamtng the daW needed, and completing and <br />i, reviewing the collection of information. Send comments regarding [he burden estimate nr any other acpecr of <br />this collection of in fornaunn. including suggestions for rrsl acing this burden, to Chir( Infnnnatinn Pnliry <br />Branch, PM-223, U.S. EnvironmenLl Protection Agency, 401 M Street, SW Washington, DC 20460; and to tl:e <br />~ Office of information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. <br />General Instructions <br />1. if form has been partially completed by preprinting, disregard instructions directed at entry of that information <br />already preprinted. <br />2. Enter 'Permittee Nnme/hfailing Address (and facility nameJlocauon, rf different)," "Fermi! h'wnber," and <br />"Drscharge Number" where indicated. (A separate form is required for each discharge.) <br />3. Euic: uates beginrJ„g and ending "AJonitorinq Period" wccrcd by I~om~ [there mdtealed. <br />4. Enter each "1'^rumrh^" as specified in monitoring requirements of pemtii <br />onicr `a:aP%~ ','.ano-..~nrnr~~ :iai;; for c:~ci: f;;;tum.,cr undo. "~'uanntp' anti ~ Gun:ut'" units specified i:t ,- rmit. <br />".~1:~r:nr;;~" is notmnl!r anthmet,c average (genmetnc average for bacreric! p.ramerers) of till sample measurements <br />for each pararneler obtained during ".Vuntlunng Perod"; "Slaximurn" and ",1!!ninmm" arc normall}' extreme high <br />and lots measurements obuuned dunng ".iJr:n;rnnug Period." (Note to municipals tv:!f: e~.:::o~•dary treatment <br />rcquircmcnl Euler 3U-day average of sangtla measurements under "Average," and enter matiimum 7-da}' average <br />of;.tmplc mcasurerca;s obt:ined during n:cni!nrint period ::rider"ilnximum. <br />6. Enter "Perrrut Rry±uremenl" for each parameter under "Qumrlily' r.n[ 'Quality" as spcaficd at permit. <br />7. Under "1b Fa" uttu ,camber of sa,uple ru.:<s,.n-c..'ils dmi;.o ronhnring patio:' t::al exceed maximum (and,'ar <br />minimum or 7-dac atrrnge ac nnnrnnriate) nermo requirement for each parameter. if none, enter "0". <br />E Fnt_r "Fro ..o n( .Inn/rcr Y' hyh ac "Cain tilt ilnn vurnlen!" (aC11Gd ffL'(leer!C, Of Sam Dhnp. and anah'SIS USeA <br />. ~_. nr, <br />dunng r.:o .;onng pcr.cd; ..::d as "f_•nr .Reyu:r.u!r,~: epc-..._ i., ;; ,." ~i; F_.nlcr "!':,,;.. fo: c,,:ainuous <br />monitoring, "Ir7" for one day per [seek, "1/30" for one day per month, "J.-; 0" far one day per quarter, ctc.)l <br />_ ~: <br />v. Enlcr "`~:,n+pir .p:' bout as ",'or,:prr tr,•n•.:vemem" (a.;u.:i >.::::pE= ;,~ .S during moi:,,~ng pcrin~;` a^d r. <br />'t'ram! t(e<ry:reu:em,_ Ic.g., enter "Glue' for utwtwum sauryic, _.,:; (u: _,-:,~~: .~~.,,yositc, ^"'•" ter <br />conlinuou5 monitoring, etc.) <br />10. Where violations of permit requircmcnls are reported, attach a brief explanation to describe cause and corrccuvc <br />actions take[[, and reference each violation by date. <br />1 I. U "no discharge" occurs during monitoring period, ewer "vo Discharge" across form in place of data emn' <br />12. Enter ".ti'ameiTitle ojPrmc!pal Executive O~cer" with ".Signature ujPnncipn! Erecuuve Officer ojAutharized <br />Agent," 'T'elephone Number," and "Date" at bottom of form. <br />13. Mail signed Report to Office(s) by date(s) specified in permit. Retain copy for your records. <br />l4. More derailed instructions for use of this Discharge Afon!toring Report (DhfR) fomt may be obtained from Olfce(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 x10,000 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) <br />