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Paperwork Reduction Act Notice
<br />Public reporting burdee for [his collection of information is estimated to vary from a range of 10 hours as an_~
<br />everege per response for some minor facilities, to 110 hours as m average per response for some major facilities, ~
<br />with a weighted average for major and minor facilities of l8 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, [o Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to [he
<br />Office of lnformation and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If fiotm has bean partially completed by preprinting, disregard instructions directed et entry of that information
<br />already preprinted.
<br />2. Enter 'Permi!!ee ,'t'ome:Mailing Address (and facility namellocauon, if diH'erenl)," "Permu A~'runber," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending ",tlumtoring Period" covered.by form where indicated.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permit.
<br />5. Enter ".Sample .1leasureurenr" data fur each parameter under "Quonrrh" anC. "OuohN" in units specified in permit.
<br />",average" is norntall}' arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each parameter obta,ncd during 'Stfoniroring Perind"; ".4!axununr" and ",tlinimrun" arc normally extreme high
<br />and low measurements obtained during "atnniroring Periyd." (Note to municipals with secondary treatment
<br />requirement Enter 30-dav a~crage of sample mcasurcmcnu under ".4nerage," and enter maximum 7~ay average
<br />o(samplc measurements obtained during monitoring period under "blaxinrum ')
<br />6. Enter "Fermi! Requirenrcnr" for each parameter under "Qunntrty" and "Qua;rty" as specified in permit
<br />7. lJnder ",No Ex" enter mrmber of sample measuements during monitoring period that exceed maximum (and/or
<br />minimum or 7-day average as appropriate) permit requirement for each parameter. U none, enter "0".
<br />8. Enter "Frequency oJ:9nnlcsis" both as "Semple rlleosurmen!" (actual freyuenc}' of sampling and analysis used
<br />during monitoring penal) and as "Permit RequiremenP' specified in permit (e.g., Enter "Conk" for continuous
<br />monitoring, "/%7" for one day per week, "I 30" for one day per month, "1 '90" for one day per quarter, etc.)
<br />9. Enter ".Sample Tvpe" bo!h as ".Sample ,i/eosurenrenP' (actual sample h~pe used during monitoring period) and as
<br />"Permit Requirement," ;e.g., Enter "Grab" Cor individual sample, "24HC"' for 21-hour rnmposite, ".N1,4" for
<br />continuous monitoring, etc.)
<br />10. Where violations of pemut requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs riuring monitoring period, enter ",M1'o Discharge" across form in place of data entry.
<br />12. Enter "Name~Tille ojPrincipal Executive Officer" with "Signature ojPrincipa! Executive Officer aJ.4uthorized
<br />Agent," "Telephone Num.5er," and "Dare" at bottom of form.
<br />13. Mail signed Report to Office(s) by date(s) specified in perntit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge ,'Lloniroring Report (DrtfR) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />Tltis report is required by law t33 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 />EIPA Form 3320-1 (Rev. 08-951
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