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Paperwork Reduction Act Notice
<br />Fu(riic re!n+diu¢ uu[den fur ihi+ wileainn of in fanna[iun i:; :.:lira: r.! e. ,-~..., i.,,.-, a ra;:ee .~f I~ Lnur. ,.."
<br />average per response For some minor faciliucs, to 110 hours as en average prr rr"^ocse for same rtr::jor facilities,
<br />with a weighted average for mayor and moor tac:hncs of 18 hours per rrspun.e, including rime for reviewing
<br />instructions, searching existine data sources, atherinn end maintaintm. rhz ,hr~ ...,~,,•+.,N ~_d
<br />g e .. o., ccmprding and
<br />rzviewin,C the collection of m(orruation. Send cununents regarding Lr burdzn es;;m,te o. a;,y ,^,;h.:r iipcct of
<br />this cnllerrinn of infnrma!jnn, inch ding suggestions Ibr rzducing thin burdau, iu CiiizL infurmaiion Foliry
<br />Branch, Ph1-223, U.S. Env[roomental Protection Aguncy, 401 M Strzet, SW Washington, DC 20460; and to the
<br />Office ul lnfornurlioo and Regulatory Affairs, Ottice of Management and Budgrt, Washington, DC 20503.
<br />General Instructions
<br />I. If fnrm hay been parti±I!y completed by preprinting, disregard instructions direUcai ai cuiry of fnat1.uformalion
<br />already prprinted. ,
<br />2. Eater 'Permi[[ce Nmne.NlailinR Address (and facility name location, if diffcrcn!)," "P:~rmir .Number," and
<br />"L'ischnrge .Number" where indicated. (A separate form is required for each discharge.)
<br />?. Enlcr da;cs beginning and et,dicg ".lf,,,,,!wur.q Penud"covered by form where indicated.
<br />4. Enlcr each "Parum,~h.+" as niiadied w u:-,,uilwwg ~cyuucmcnls of permit _
<br />5. Enter ".SU~,rplr ,11:-u~u.r•mrrr" loci fw tacit parau:ucr under "Ounnlitt" and "Quality" in umK specified ur pzntti[.
<br />".I r[-rnRr" is normdll~ anthmcuc atrnge (gcontcuic atuage (or bacterial parameters) of all sim;+le measurements
<br />Ibr cash para,oci~r ui;l:WiuCd dwtng':'.lururrrr,,r; 1'.n,:~P', "Slurrnmr.r" and "dlinimum" arc nar-~r ;. i:r;lreme high
<br />and low measurements ohlaincd during "]:nnir»,gz l',norl" (No~c to mtutieipals with tcenrca._; treatment
<br />r~yuirtuicui Eni,., ?~: -:Li. ut ciag: o. ~.iu~pi= m;::_~.: c:'„u;u an~i-: ... ~:.+ge," and cuter n-~c,:::-r_, . )day a~cragc
<br />of sample measurements ob!atncd during monitorng period under "' ;,~*4,nun. ")
<br />h Fnler "Pernnr R,•yu,rrmrnr" for Cac!! p:rra.^..cle....!d•_ "Uuami: .~~.d "~)r:r.!ia' ,.~ ;pc^Sed in permit.
<br />7. ! ender "+,r. Er" c.^.tcr .^.a:rbc: cf s:.r,:p1c s:casurtn:ns dunnfi :~;onitoring f,:r,a:: 1-~a1 ..,cecd maxlAlum (and/or
<br />miuinwm or 7-day :nengc as apprnpriaic) pain+it requirement for each parmnctc. :...-.~.c, enter "0'.
<br />.• c.,..._ ,~,.- [ ~ :;nui.rare" uoiii as ':;wnpic 1iru.wnneui" (:aiuai frcyu~uq of s:unpimg and xualys[s usud
<br />~,. ~.u,u ,~:~n,en.v u'
<br />dunng monitoring pcrmd) and as "l'eruut kryuirrmrur" specified m perms (eg, Eu1cr "t'un[," for continuous
<br />.T.C.^.::0^..^.b, "/ ~" fJ:....: .'~.-. Y_: .. ~..... '; ~~' (W W:C :: iii, .: Ai:: u. 'i .~i .. ~ JiiC d:ij y~r .~. i:, ::i. CIC j
<br />9. Emcr ".Sump/r /tpr'~ bosh as ':~nmplc ,1>eo~urernrnt" (actual sample type useu dunng mnedonng pcnetl) and as
<br />"Pernut Requvement," (ag, Enter "Groh" for mdnidual sample, "?all("' for 24-hour composite. "~`:-1" far
<br />continuous monitoring, etc.)
<br />10. Where violations oC pernut requirements are reported, attach a bncf e.~planation to dcscnbe cause and corrective
<br />actions taken, and reference each violation by date.
<br />11. If "no discharge" occurs during monitoring period, enter "No Discharge" across form in place of data entry.
<br />12. Enter "Name/!'ille ojPrincipal Executive Officer" with "Signature ojPrincipol Executive O~cer ojAuthorized
<br />Agent," "Telephone Number," and "Date" al bottom oC form.
<br />l3. Mail signed Report to OtTice(s) by date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Afonitor[ng Report (DtifRJ form may be obtained from O6ice(s)
<br />specked in permit.
<br />Legal Notice
<br />This report is requiredl 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 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 />EPA Form 3320-1 (Rev. 08-95)
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