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Paperwork Reduction Act Notice
<br />fha:Lc :~oo!inC bcrde^ I~~r lh!s' ro4c:no^ u! ...^.rnn,,.~.", -;:. .. -.~.,.~.:.' ~.~ ~„ ,;;.+, r..-n: a .a~c._ -•f 10 !;ourc as an
<br />avenge per response fnr some minor facilities, to 110 hours rs an eve,e?e per resnon~r fnr "ome major f!ci!irics, '
<br />with a weight;-d average for major and minor facilities of 18 hoary net response, including time for reviewinn
<br />instruction:, re.:rching existing dal sources, gathering end mainr~'trucg the d?r_~ needed, and comp!et:ng ~.d
<br />rcvi~ :•ing the col!~.[!o^. of infor*.--alien. Send com_mrnls regarding the b•~•_~rn e°[r;•;_t~ o, ,~~ „then z~prct o~
<br />iiris wlluaiuu of information, including suQgstions for rcduc~ng this burden, to Chief, lnformation ^olir;
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Sired, SW Washington, DC 20460; and to the
<br />Office of lnfotmation and Regulatory Affairs, Office of Managemrnt and Budget, Washington, DC 20503. I
<br />General Instructions
<br />1. If farm he, bceu partially completed by preprinting, Disregard instructiuo; dirut.;d st ~::t,y of [hat information
<br />already prepnnted.
<br />2. Ente: 'Perna!!^.= .Nnrne!!llmlinR .4ddress (and facility nameRxation. if diff•rrmj," "Permit Number." and
<br />"Discharge .'amber" t+here indicated. (A separate form is required for each drscharge )
<br />3. Enter dates beg!nning and ending ",tlunirunng Pernxf" co+ered b} form HLuc indicated.
<br />~. Fntcr r~, h "I'nrnnrnrrr" ac spcuficd in monitoring rcquuemcnts oCperr~ni
<br />5. Enter "A7nnple 1 /erccurrnuml" data fur each parameter under '~Ouon;.r~" and "Quolitr'" in units specJed in pcrniit.
<br />". L',~rgg•" is normalk arithmetic average (geometric average fnr bacterial parameters) of all sample measurements
<br />far each paramc!cr obtained during "ttnnunring Perin J", "Slrvnuun" and ",1linimum" arc nonnall~ ,.~treme high
<br />and low measurements obtained during "11oni(oring /'rrmd" (Note to municipals ++ith sceond2~' ~ eatment
<br />requiremcm Enter l!I-d:p aven!gc of sa:;~pie n!casurcm~:~ ':iveroga." and enter m,f.v:..~ . :' :,q a+uragc
<br />of samp!c measurements obhuncd during mor!!oring period uncicr "1lnnmunr.
<br />o. onion Frr'b:n ~_:~dc• "(1':r.,ahl'' and " h_,o rh" zC S caf!cd in ~_rmn.
<br />' ' R, gau~.;re;;Y' for each para.rctcr 1 C ~ l P P'
<br />7. Under "i~'n cz" enu;r uuwucr uC satiipic m~&oo~:,:..rds wring monitorng t;c c' that c:^=d mauimum (sndror
<br />minimum or 7-da~~ a+cragc as appropnatc) pcrm~t rcqu:rcment for each paiarr..:l~r ii none, en(ct "v'.
<br />B. Fnler "hreyuenn' o/ .4nnl vcr.c" both as ".\umpie .iiracuru!eni" (a~iuii :reyuuiC) tit san~,pttng an„ ~:naiysis used
<br />r1 ~.!ri n~ a:nnnnrin^ period) sod 2, "Perrnil Reguirr'n;en(" specified m pcrnu[. (c. g., Enter "('ont,"^(or continuous
<br />nunuioring ' r - ~ fur one de. pu ++cce, "/-3C" fv; c,~-.::.~. N..~ inc!,;L•, :" n7" '~u~ o:-. dsv ;,r quarter, e!c ,'
<br />G. Later ".\~inyi~ rly~" b01h ar "~:cn;pl:' ~. !C ^.c::re,r:.^P (" (7~~L'°~ F'lmnlP f~-pc ncet• m~nn~ mrnnlon ng penuu! .a iu ab
<br />,:,. r.
<br />"l'rrmrt Rrgvrrcm:nr," (e g , F.nter 'V rruh" for uidii.!d:'a) c,mplc, "?al/C"' for L4-hour composite. .' !'~" ~r
<br />continuous momtonng, etc.)
<br />10. Where ciolauons of permit requirements are reported, attach a brief esplanation to describe cause and corective
<br />actions taken, and reference each violation by date.
<br />1 t. If "no discharge" occurs during monitoring period, enter ".\'u Drechurge" across form in place of data entq.
<br />12. Enter "Namerl'i(le of Principal Executive Officer" with "Signature of Principal Executive Officer ojAuthorized
<br />Agent," "Telephone Number," and "Dare" of 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 Afonitoring Report (DtifR} form may be obtained from Of}-ice(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 out 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 />
<br />EPA Form 3320-1 (Rev. 08-95)
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