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Paperwork Reduction Act Notice
<br />/„IIIIC rrpnrt°~,£ h°'idYn !, , !111ti '_, 11:^i l'rl ill fli 'llafrl'{i 1111. ~] : .: i11iNi ~'.. ,J \.1:1 I: t,:il ~ 16i1 ~': 'll Ili Ilnar\ a5 an
<br />' xverage per recnnnse for some minor Facilities, to 110 hours as an average per response for some major facilities,
<br />with a weighted average for major and aunor facilities of 18 hours per response, mctuding ume for reviewing
<br />instnictinns, sl=arrhing exictina data sources, gathering and maintaini.~g Lhe data needed, and completing and
<br />' reviewing the collection nF infnnnation. Send comments regarding the burden estimatu or any other astxct of
<br />~I this collection of in Formation, including suggestions for rrdul•ing this hordes, to Chirf, Ink,rmaKnn Policy
<br />~ Branch. PM-223, U.S. Enviroomeotal Protection Agency, 401 A4 Street, SW Washmg[on, DC 20460; and to the
<br />Office of Information end Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If farm has been partially compl_ted by preprinting, disregard inctnictinnc directed ar entry n( that information
<br />already preprinteal.
<br />2 Enter 'Permirree Iv'ame/Mai/ing Address (and facility ttamrJlocation, if dit7erent)," "Permit Number," and
<br />"DicchorRe A'umbrr" where indicated. (A separate form is required for each discharge)
<br />3. F_ntrr dales beginning .wd ending ",l1on,WrmK I'.riod" covered by form where indicated.
<br />4. Enter each "Foramen-r" as spc~ificd m monnonng requirements a(pcmut.
<br />5. Enlcr ".`.ouip/e .ilrasurrmenr" daCi for wch parameter under "(hmnlih" and "QunLit" in units spcdGcd in permit.
<br />".averone" is norn><111y arithmetic average (geometric average for bacterial parameters) of all sample measurements
<br />for each paramc(cr oblaincd during ",tlunxurinr; PeriuiP', ",1ku~inium" and ":1/inunm::" a:e normally extreme high
<br />and low measurements oblaincd during "1/nmmnirk Period" (Note to muniapcls ~..-~t:. secondary treatment
<br />requirentem Enter )0-da} averagu of sa;npic uiuuuruuCt~da under g-" n:~? c,.ter -r:imt:m 7day avemgc
<br />'.Lr;o
<br />o(samplc measurements oblaincd during monitoring period under ",t/aximum. ")
<br />6. Enter "Perini! Requrrernrni" for rock parameter under "(JunnrHv"and "Onnlih•" as sp~rificd m permit.
<br />7. Under ".',~, L:r" enter numbs of s:,mple me:uurn:c.^.L during monitoring period that r•~~cerrl macimum (and/or
<br />mtmmum or 7-da) average as appropnui~:j permit icyuircnieid G;r urch p,,ianteter „ r:onc, ~..-..cr "0".
<br />_ .... ~ ~ ,
<br />l J ~ .th-a;~.,~rnr:!` ,....,,..., :rcyurr:~_. a: s...p....e ._..,.
<br />S. triter rreruenrv o',irmi~.,is' uuiu m 'Yd,ii,~ll: ,°"...,.: .:^~ ,~~. ... _ _t.^-^sls ~,_.:..
<br />during monitoring period) and as "Perirur Kequu•ement" speetGed in pcrnrit. (c. g., Enter "Cbnr," for continuaus
<br />iuoniioriug, "1 %' Ibr u.x d.,j p... ,,,.r',:. ° I _; 0" Ccr ,.,,: d,.~ per e:oa~F, ^ / ~i;n" =r,r one day p!" nl;,~°r etc 1
<br />9. Enter "Sanip/r %tpr" both aS "~'riniple 11en.currrnrnY (actual sanlpic type used during uw„~w~iil,g Na,..dj ,:.,~ ..:
<br />"Permit Requirerneni." (c.g.. Enter "l;rnh" for mdilidual sample. "]JHC" fur 24-hour composite, "~'A" for
<br />continuous momlonng, eic.j
<br />10. Where violations of perrrut regwremems arc reposed, attach a brief explanation to describe cause and corrcdice
<br />actions taken, and reCcrence each violation by dart.
<br />1 I. U "no discharge" occurs during monitoring period, emer ",vo Discharge" across (otm in place of data entq~
<br />12. Enter ",Name~Tirle ojPrincipa! Executive Officer" with "Signature ojPrincipa! Esecurive Officer ojAu(horized
<br />Agent," "Telephone Number," and "Dale" at bottom of form.
<br />13. Mail signed Report [o Office(s) by date(s) specified in pcn»it. Retain copy for your records.
<br />14. More detailed instructions Cor use of this Discharge.4lonitoring Report (D.4fR) 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 b 10,000 per day of violation; or in criminal penalties not to exceed SZ5,000 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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