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r- Paperwork Reduction Act Notice -
<br />Public repor.ing burden for this collection of information ix estimatrd to vary f,,,.,n ~ .-. ~ ~r 10 hour, ~ nit
<br />-. -r r. •r•m..:u::.....c rni r. r.' ......,.. +,.. „ou,~:. ,~ "„ ...c. nge per iwpuaae .or some mayor tacrhues.
<br />~ with~a wzieh[ul evzr_~~ ~ %r.r ~~-rjn- ~~~r ml.,~; F+~_Ihhes of ! E hours per r~:.pu¢;,;, L}ciuding trnrn iur reviewing
<br />' instructions, swrchius e::isting da'v~ sources, garhering and maintaining the date ¢eedzd, wid wmplzting and ~
<br />lev iewutg the colleccinr. of information. Send comments regarding the burden estimate or any other aspect of
<br />ibis wllettiun of information, including suggzshuns for reducing this burden, to Chief, Informatron Polley I
<br />~ Branch, f'M-Z"23, U.S. Environmental 1'rob.Atiun .Sgzrr~y, 40i ivi Sircci, SW 1v'ashingw¢, Ui- A)460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Was}ringWO, DC 20503.
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<br />General Instructions
<br />1. If form has bee¢ partially completed by prepri¢ting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. E¢ler 'Perini(lee Name:Alailing Address (and facility name/location, S differenQ," "Permit Number," and
<br />"L? crharge ,,".'umber" tivhere indicated. (A separate form is myuired for each discharge.)
<br />i. Guic~ dales beginning and ending "ilonnnnng Period" covered by turn[ where indicated
<br />?. I'nicr ^acl+ "Yrv.^n, i"rr" ..'~ ~peci Ice I:~ mcnuorin{' rcquircntcnls of pcnnu.
<br />5. Enicr "'.:.r,~!: 'Jr e; u;r-„ ,;(" ...t.; fur w~ii pmaurctcr under "Quanr,n•' and 'iiunhrt" m wins spectGed in permit.
<br />".4~~rrn~r•" is nerntal!~ anlhmctic avenge (geomNric icerage for bacterial puiametcrs) of all sample measurements
<br />(nr each parameter oMmr.etl dtrnug ".I;nnrl,lrin, t'~r'i„S'; ",tlnzlumm" unu "1 'Irimuur" are notntally ~erireme high
<br />and loo measurements obtained during "1/nnn~uvn; Period." (Note to r.r •. ~icipals with secondary treatment
<br />requirement. Enter 30-da} avemF;c of samolc measurements under "-R•rrnor," ^rrr tenter maximi!r^ '/-~ -} avcmgc
<br />of san~pic meaaurcuieub ubtarned dunng monitoring period under "Afaximum."1 .
<br />6 toter ";'enrol Hcn~arcnrcnt" far each pnrimctcr unds "~)u~onh" and "Quatitp" ss specified in pzrwil.
<br />7. Under ".~'o h: r" enter number of sample measurments c~urng monitoring period that exceed r:~a-timum (and/or
<br />minimum or 7-dav average as a¢ornnnatcl ocrmrt renru rrmenr rpr rnrh nnrameter If nnnr. r^~/^ "0"
<br />% tnlCr 'i're(/I/Y llrt• nl .Iwgli <rp' both '+< "\'-, ~/.• 1 r.,. ,... .. r" nb•^i r-^y,~rne,~ n( ~ -~~- - ¢SCd
<br />during m¢nilonng ocnod) and as "Prrrrn! krquu'rurror" spccifcd ~^ pcr::ul. (e.g, Enicr "C'unl," for =ondnuous
<br />menitnnng, ")'7" ter one da}' per a Wit., "/~JO" f::: roc da; ,~ r maa: n, "/r.n/1., far cne. ria}' per quarter. ctc.l
<br />t1 Enrer "\'nrn n7e 7 i rte" both ac "\n nl.. ~ Inm nrn... ~.~, h ,al sa ^tple .•'~ '~,• ••j mCR1tOr,ng pe..'a' --...
<br />"Pernur Reyuvernrnl," (c.g., Ewer "Uruh" fur mdi•rd~!ul sample, '`'lilt ~ fur d-hour composrlc. ".\ :!" ror
<br />continuous momturint;. etc.)
<br />10. Where violations of permit requtremenls arc reported, attach a brief evplanalion to drsrribe cause and corrective
<br />actions taken, and reference each violation by dal[:
<br />11. If "no dtscharge" occurs during monitoring period, enter ".h'n Discharge" across form in place of data entry.
<br />12. Enter "Name/1'i(le ojPrincipal Execu(rve O~cer" vlilh "Signature ujPrincipn! L:Yecu(ive Officer ojAulhorized
<br />.4gen(," "Telephone Number," and "Date" at bottom of form
<br />13. Mail signed Report to OfTce(s) by date(s) specified in perttti[. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afonitoring Report (DAIR) form may be obtained from OBice(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 a 10,000 per day of violation; or in criminal penalties not to exceed 525.000 per day
<br />of violation, or by imprisonment for not more [Fran one year, or by bosh.
<br />EPA Form 3320-I (Rev. 08-95)
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