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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estirnatrd to very from a range of 10 hours as an
<br />average per response for some minor facilitres, to ] 10 hours as an average per response for some major facilities,
<br />with a weighted average for major and minor facilities of l8 hours per response, inctuding time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining :he data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of information, including suggestions for reducing this burden, to Chief, Information Policy
<br />Branch, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed a[ entry of [hat information
<br />already preprinted.
<br />2. Eater 'Permittee .h'ame/llfailing Address (;md Cacility namellocation, if different)," "Permit Number," and
<br />"Discharge A'umber" N•here indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending "Afoniraring Period" covered by form where indiczted.
<br />4. Enter each "Parameter" as specified in monitoring requirements of permi,.
<br />5. En[er "Sample ,1leasuremenr" data for each pa.^ame[cr undo "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally arithmetic average (gccmetric average for b. ctcrizl parmeters) of all sample measurements
<br />for each parameter obtained during ".lfonimring PerincP'; ".t/aximu.n" arrd ';tlinimunr" arc normally extreme high
<br />and low me,~tsuremcnts obtained during "'.lonilonng Perrnd." (Note to municipals r~ith secondary 1rca0nen[
<br />rcquiremenC Enter 'i0-day average of ;ample me<~surements under "Average," and enter maximtun 7~ay average
<br />of sample measurements obtained during monitoring period under ",~faxirnum.'J
<br />6. Enter "Perna Reouiremenl" for each parrLne[c under "Quantity" and "Quality" as specified in permit.
<br />7. Under ".4'a Fx" enter number oC sample measurmcnts during monilori.~g period that exceed mawmuni (and/or
<br />minimum or 7~a}' average as appropriate) pcnnit requirement far each parameter. If none, enter "0".
<br />B. Enter "Frequency ojAnalysis" both as "Sample rLleasurmem" (actual frequency of sampling and analysis used
<br />during momloring penod) and as "Pernrir ReyuiremenP' specified in permit. (e. g., Enter "Conn" for continuous
<br />monitoring, "tr7" far one day per v1•eek, "1x30" ;or one day per month, "1/90" For one day per quarter, e[cJ
<br />9. Enter "S'mnple Ttpe" both as "Sample .lfeasur~nrent" (actual sample t}pe used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Orcb" Cur individual sample, "3~HC' for 24-hour composite, "N/A" for
<br />continuous monitoring, etc.)
<br />10. Where t~olauons of permit requirements are reported, attach a brief eeplanation to describe cause and cortecOvc
<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. En[er ".Vame/Title oJPrincipnl Executive Otter" µ~ith "Srgnarure ojPrincipnl Executive OJTcer ojAurhorized
<br />Agent," "Telephone Number," and "Dare" at bottom of form.
<br />13. Mail signed Report to Office(s) by dale(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge Monitoring Report (D,i~R) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />71tis 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 />resyltyb c"tvil 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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