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Paperwork Reduction Act Notice
<br />~~ 1~IG In\ hat Ll~l: f~. it tl!!J lllif Rt1U11 Ui ... fVli.~Win,L• ,S t'Sii!i~•'. ~~ iJ •01 f1 U:i1 ~ !,lilel ._~ Iii {p~
<br />urti a, an
<br />average ner response for some minor facilities, to I10 hours as an average per response for soma major facilrties, '.
<br />', w![h a weighted average for major and minor facilities of 18 hours per response, metalling hme for rev!ewmg I,
<br />instruction., searchioe existing data sources, ea[herin,q and maintaining the data nulled, and l:ompleting and i
<br />reviewine [he collechnn of information. Send comments regarding the burden estimate or anv other a_snela of I
<br />[hts cOllecrinn of infnrmatinn, inrlndinv suoorstinn.c far reducing this harden, to C'hir.f, Infnrmatinn Ppli:_y
<br />9ranch, PM-223, U.S. Environmental Protnchon Agency, 401 M Street, SW Washington, DC 20460; and to the ~
<br />Office of Information and Regulatory Affairs, Offce of Manxgemenl end Budget, Washington, DC 20503.
<br />General Instructions
<br />I, If fprtn hat F+een partially rmm~lrfrtl by pieprlnting, disregard instntetinnc dvr~te[i at rn try of that infnrmatjnn
<br />already preprinted.
<br />2. Enter 'Pcnnittce A'nrne~;llmlinq Address (and facility name location, if tiiH'crcnq," "Permit A'un!ber," and
<br />"DschnrRe ~~umber" where indicated. (A separate form is required for each discharge.)
<br />3. Enter darts beginning and ending "." lomtr:rm,q Period" covered by form where indicated.
<br />4. Enter each "Pnrronl t%~r" as spectfied !n n;onnonng requirements of pennn
<br />5. Euler ".Sumpir.llrmwimrrt" data for each paramrtcr under "~lunntih" anti "(%unh(;" :n units spca`;.d in permit.
<br />":I vcro~?r" is norma'1}' arithmetic average (gcomcutc assagc fur bacterial parameters) of all sample ,,casurements
<br />for cash para!netcr obl<vncd during :'.l;r.nn„r!n}; Prr!~,o"'., ".t:;aunuu!" an ; 'aLnunem" arc uonuallj ~ctreme high
<br />and low measurentcnls obtained during ':11uru1uri!iq !•enuu" (Note io mumapals with secondary treamunt
<br />il:gwtcn KUi LI!ici 70-uLY a'. Cieg~ of .:Ni ::.~_'~ -..~i2r' iP:. ,'e,~ -,a. C,~~~, mn.~: ~:..u17-0ay a':.^..^yC
<br />of sample mcasurcmcnls o6laincd during monitoring pc.-.od,undcr ".tlarunv!a
<br />6. Fntcr "Prrrnd Regvuvmvnt" for each pnrnmctcr under "Qumvi~y' and "Uunhty" as spectfiee :n ,omit.
<br />7. Under "~':; Pte" •..^.Ter numbs of sample r*!c~s~ir~,^^~s c'o~,'~ mo ritonng period that exceed ma;:imum (and/cr
<br />wiui uium or ivi.p al..~agc ,~, epi,c~pn,u~i ~.., ::~.; ,..y,:~,..,n.::; .'., each N,;rameler. If :ane, enter "?".
<br />a. [:.liU "!'iiyi,i,iiy Jl .iiinil:;l.. wln :u .:aClr9!~ .'.:.•~,;..,;;:.;:' ta..1_: ::C'y'l:':!:'_} of J1!::f:::(, _ r_ d!-!!i1_~• !~sed
<br />during monitoring oeriodl and as "!'error( Requu•emen!' specified in pz, uut. (e.g., Enter "Con1," (or tor, iinuos
<br />:uo::i:o: i. b. "! 7" for cr :; d ;} F" .. r F:. ': t'~tr" !•.•: r ..::y per mpn,th, :' Irn~. far rent tint rcr quarter, etc !
<br />9. Enter ".tinrnpie itpr' ooth as '.vmnpre .urmurrnuan t,amai sampi.. „~,. 1.~.,; ,;.,;;rt, „wuiloiiug yl,!,1,,:; _.. :.-.
<br />"Prnutr Rrgmremenr," (e g.. Enlcr "Groh" for individual sample, "?~1!l"' for 24-hour composite, ".~`.~"y far
<br />continuous monitoring, etc.)
<br />10. Where violations of permit requirements arc reported, attach a brie( esplanat!on to describe cause and co rrcCi:c
<br />actions taken, and reference each violation b}' dale
<br />11. U "no discharge" occurs during monitoring period, enter ".Vu Discharge" across form in place of data entry.
<br />12. Enter "Name/title ojPrincipn! Executive O~cer" wt[h "S'ignnrure ojPrincrpnl Executive Officer ojAuthorized
<br />Agent," "Telephone /Dumber," and "Dole" at 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 ,4lonrtoring Repor( (Dh/R) form may be obtained from O6ice(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 E10,000 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 />EPA Forro 3320-1 (Rev. 08-95)
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