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Paperwork Reduction Act Notice
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<br />Public reporting burden for this collection of inform?tinn ie estim-t.d to .ary fn~m a ran_„ nr !0 hours: as an
<br />aer,ao. '-:• rc_;:Jaye far :~,m., cu~cr ta..,i:Les, w i 10 hours as an average per response for some major facilities, ~
<br />with a :rcighied average for manor and manor fu:ilitics of 18 uou~ per response, including time for reviewing '
<br />instructions, searching existing data sources, gathenng and maintaininc [he data ^eedud, and competing and
<br />~ rcvrewin the collecuon of information. Send rnmmenLs re ardin [he burden estimate nr any other ^f ~
<br />s s s ~,pa , .,
<br />' tws rulia;iiun or" information, including suggestions for reducing this harden, to ChieF, !n forr.,ation Fulicy
<br />~ 9[1-+nch, PDA-223, U.S. Environmeoiaf Fruicelion ,vgency, 401 IN Street, SW Washington, DC 20460; and [o the I
<br />Office of Information 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 completed by preprinting, disregarJ instructions directsd a ent:~ :;( that information
<br />alrwdy preprinted.
<br />2. Enter 'Pernrrrrce Nameiblading Address (and facility name/localion, if dilfcrtuQ." "Prrmir -\5rmher," 2nd
<br />"!`!cr!:a:-g; ,",'u.:;;her" uhCre indicaicd. (A separate form is regwred fur each dtschargc.)
<br />3. Er:(c, d::ic:, beginning and ending 'Slfunitorrnc Penrrl" cm~ered by form where md~cated.
<br />4. I~nler ear_!' "1'arem~ r'r" as specified in mouiwnng tatwrcments of pernul.
<br />:. Enter "`;m;;1~4 .'„~us~r rr,:rni" data iar each parameter under "UuanriR'" an;' "Q;,alirv" in units specified in peanut.
<br />"A~~ern~e" is normal;y anlh mcllc at erage (geometric aterage for b~cttrial panrmeters) of all sample meaarrements
<br />for each parurnetcr etC:ined d~:ring ';llurrt~uvng Pcrru,f', "t!u::rnwr:" and ";.hnimum" art norntil:~ ezc;eme high
<br />and low mcasuremcr.ls obtained during ".1luniruring Pcru,d." (Uma to municipals with seconrlaq' trearmem
<br />requirement Enter l(1-dar avcrn~c of a'nnlr mrasuremenLc '.coder ".!r:; :x e," and enter ru;r.i~•~.. ~ ~:a~ average
<br />of sample mcwsuremuus obtained dunng mmutoring period node- "nlarirunr. ")
<br />6. Enter "Pc„-r! P.cy::r:,.:,rr.." fu.::.u~ parameter unocr "Lluanuh'' and "flua6ly" as S.CCi~ied in permit.
<br />7. Under ".\'u Ex" enter number of sample mcas.:rmcnts during monilorine perirc ±t•a'. cr;reedmaximum (and/or
<br />minimum or 7-oay avcraee as anpronr:atet nn.m,r .c ,_'t~cmrnt for each parantetcr. roc, enter "0".
<br />k hnlCr 'Nrvnurnrr nr .1 r•.p q~~" ~~•~ ^...'. "~•.~.:.::,:. .'. ': ~~..,.. ..:: ,.:" ~: ~.•__.. _.cquC:"_) .. ^:pti ;g aiid aiiut~5i5 used
<br />during monitoring period) znd as "Prrnnt Rrquireurcnr" specified u'. pcruit. (c.g~,~cnlcr "C'unr," (or continuous
<br />monitoring. "!~7" for ant d;.:y p.r v.'._rk, "I~JO" for nr.c uo', .-~: moo;h ' I.';r" G- ~c day p=r :1:::^cr, et: ?
<br />G. Enter °.Cmm~lr '/1,~nn" both ? "l'^~:~^r; !, r,•gc• (;,:; ,,.,;~y;~ ~.N.. ~ ~ •iLLrlRg mOnlWru,'z pr.~a~t) and as
<br />„//~C %~.. iii' ,IUI - ~~.
<br />"1'ermir Regmremeni." (c g,, Enlcr "(irnh" for mdtridual camplc, "?J//(~" for 24-hour compasilc. "~~:1" for
<br />COnIIRLLOLLS n10nllofinP CIC )
<br />10. Where violations of perntil require nrents arc reported, attach a brie, c~planalion to describe cease and corrective
<br />actions taken, and reference each tiolation by dale.
<br />1 I. U "no discharge" occurs during monitoring period, enter ".No Discharge" across form in place of data entry.
<br />12. Enter "Name/I'itle ojPrincipal Executive O~cer" with "Signature ojPrincrpal Hxecurive Officer ojAurhorized
<br />Agent," "Telephone Number," and "Dare" a[ bottom of (orm.
<br />13. Mail signed Report to Offce(s) by date(s) specified in permit. Retain copy (or your records.
<br />14. More derailed instructions for use of this Discharge Afoniroring Report (DAfR) form 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 $10,000 per day of violation; or in criminal penalties not to exceed $25,000 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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