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Paperwork Reduction Act Notice
<br />I Public reportin¢ burden fnr this rnllrrrinn of i,.ln.rn,t~~n ~'- estimat.:d :o 'vary fr,u., a ra,igc ..f 10 h„urc a=. s^.
<br />•^"~6" Y°' ,wY~ua~ lu, au.uo ruiuu, fm;iliiies, to ;!0 hours as an average per response for some arajnr facilities,
<br />wrth a wrigh!cd at~eng:. far :na)or ::aJ moor facilili„s of 18 iwun per response, inctudmg brae for reviewing ~
<br />' iasiructioas, searching existing data sources, gether.ng and [naintaining [he data neaclul, and completing a_nd
<br />reviewing the collection of infonnntion. Send comments regarding the burden estimatu or any other aspect of I
<br />I this collechoa of inlarmatlon, including suggestions for reducing Ihls burden; to f'hiNf, Inform~tio.^. Policy
<br />B:-"ash, F1.f-223, U.,^. cnviunmlcuial Protution Agency, 401 M Sheet, SW Washington, DC 20460; and to We
<br />I Office of Information and Regulatory Affairs, Office of 1\tanagemcnt and BuJget, Washmglon, DC 20503.
<br />General Instructions
<br />I. If form his been partially completed by preprinting, disregard insWctiuns directed ar rnrr;• of that infortnauea
<br />already prepnnted.
<br />2. Enter 'Permu(ee h'ameihlmhng Address (and facility name/IocatioR d dilfcrer.Q," "Permit Number." and
<br />"D~~, hnrxr \iunl,rr" whets indicated. (A separate Conn is regwred for each discharge )
<br />~. Fnter dales beginning and ending ".4fanimrrne Permd" crnrorcd b} form where mdicatcd.
<br />,. =r.ic: eau; "1'ara,nr.r" as specifieJ ui uwnumiug requucnteuts of pcr!nit.
<br />5. i-ula ",Surelrlr .iieamrr,nenr` data fur each parameter under "(fuunliR%' and "Qua6(}" in traits sp,riG;;rf, m pernul.
<br />"-t ~erc'Pe" is normal P, arithmetic average (geometric average for brstedal parameters) of all sample t,~casurements
<br />for each ;aramcicr oblaineJ during "S fomrorinK ~ r~'~.rf'~ ",41n.rum'~r" and ",1lrmmuru" r;c . cr.malh c~7rcmc high
<br />~md low measuremcr.ts obtained during ".tlonuurua, 1'criod." (Note to municipals ,ril•.~. secondary treatment
<br />requuement~ Fnir,r ltl-dac avernec of samnlr mc~s'~~cme^'~ !radar "Average," and crk- -n_:~r-'ur„', d,~y a,~c:~z
<br />of sample measurcmcnis obnuncd during monitoring pcncd undcr'alazimum. J
<br />G. Eidn "Pr,-.r.n i:eyuirrmen(" for each parameter under 'tJunnn(V~ acid "~h,ali!v' as spcaheC i,i permit.
<br />7. Under "t'n h.'x" ,,^nter n,rmbur of sample measun:~cnls during monitoring acriod that eececd maximum (and/or
<br />I111n11Tlnlp pr 7-dev a\ Cr1nr• ~c anompriate) permi! req:~~mment for each ^ . ~-re?_- 1f none. ^n;cr "0".
<br />. .r ... ... ... ~ ... ~.. ... ..,,, , ~'_ ... D.....e....b ' ai ... r. u, .,,
<br />during mom!oring p_ned) and as 'Permit R:quiremrnr" specified in pcrrait (cg., Enter "C'on1," for continuous
<br />atoniloring, "/ 7" for unc dt~ f,•_r is•_~_:: ". ;;1" for one Jai pa nwW.i:_ "1;917.' fnr one day per quanrr crc `,
<br />o Fn,or "ln.r../,. 'n .., .,, M,6 ..~ "o .... ,./. ,r ... ..-... ....n ,.. _....n ..__._i_ - ~~~ dUrl^ Ilil/llllltl iu i1vJ GIiJ d]
<br />.. ..-. ~ :.~ _...:. __ _ ~.~ .. .... .......~.: na.m td-:.:.u :..,...1;.., lY` °. li 5 N~ 7
<br />"Perm,( Requrreme~t," (e g . 'toter "Groh" for iadicidual sample. "ZaHe "' for 24-hour composite. ".V :4" for
<br />rnnh nnMg mnnitnn ng rir )
<br />10. Where violations of pemrit requirements arc reported, attach a brit( explanation to describe cause and corrcti~c
<br />actions taken, and reference each violation b} date.
<br />I I. If "no discharge" occurs during monitoring period, enter ".~'o Discharge" across form in place of data entry.
<br />12. Enter "1v'ome•Tit1e of Principal Executive Officer" with "Signa(ure of Principal 1•.'xecutive Officer ojAulhorized
<br />Agent," "Telephone Number," and "Dale" at bottom of form.
<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 Afoni(oring Report (DA-fR) farm ma}' 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 $10,000 per day of violation; or in criminal penalties not to exceed x25,000 per day
<br />of violation, or by imprisonment for not more than one year, or by both.
<br />EPA Fot-m 3320-1 (Rev. 08-95)
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