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Paperwork Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a range of 10 hours as m
<br />avenge per response for some minor facilities, to I IO.hnurc as m average per response for some major facilities,
<br />wi(b'a weighted average for major and minor facilities of IS hours per response, including time far reviewing
<br />instntetioos, searching existing data sources, gathenng and maintaining the data needed, and completing and
<br />rgviewing the collection of information. Send comments regarding the burden estimate or any other aspect of
<br />this collection of intonnation, including suggestions for reducing this burden, to Chief, Information Policy
<br />Bran, PM-223, U.S. Environmental Protection Agency, 401 M Street, SW Washington, DC 20460; and to the
<br />Office of infotmaticm and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503.
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<br />' Generat Instructions
<br />1'. If form 1-rs b:en partially completed by preprinting, disregazd instructions directed at entry of that information
<br />already n.epnnted.
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<br />2; Enter "Ycrmirfec :'nme.;Llaihng address rand facility tiame/location, if diBerenQ," "Permit Number," and
<br />' "Dischnrgr Number" ',:here indicated ~A scpa:ate form is required for each discharge)
<br />3. Enter dates beet,ming and ending iLfunimring Pcrind" covered by form where indicated.
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<br />~4; $ntcr each "Pn,•amerer" ai :;pacified in monitoring ruluirements of permit.
<br />5: Ecter~"Sa;,p;e• !!, anvemrnr" data for each pa,anieter under "Quantity" acid "Quality" in units specifier( in permit.
<br />",4veragd' is ~,1rm"tlly arithmetic ascrage I qc, metric average for bacterial par„meters) of all sample mtasurememts
<br />for each parar.et^r rbtained doting "dfon.r~nny i'n~inrl"; ':1/aa-inn•m" and "b9nirnum" are normally extreme high
<br />and Ipw measuremzrts obtained dining ':'.ro,,r~.r;rb Penod." (Nora to municipals with secondary treatment
<br />requitrmctd: Eater 30-da; averag.~ of sample measurement, wider "Average," acrd eater maximum 7-day average
<br />of sample mea<Jr_menL; obGmned during m^niinr+ng peered under 'Stf2t-imw;r. "i
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<br />161 Enter "Pcr~n~r,2vouiremc^r" for ach pa...metu ut.:..r "t~uon:,:y" and "Quali:}~' as specified in permit.
<br />7. Undzr ":~: Fr" er;cr number of s!r.iple meacur;aaits During monimring period that exceed maximum (and/or
<br />tf i ~ minirtlura x ~-day ac:.rage as approp~ate) p, .-~ -i! reouirement for each parameter If none, enter "0".
<br />fi Enter "F-~qv ~ ~.•. ~ .rA,m!iare" bo1t~ %s "J'm~rpG~ A:vorur,nent" (actual Fegeenry of sampling and analysis used
<br />~~ doting momtc. r~ p^rad, ^r,? a_=. "; apple P.rqua ~•n:en~" specited in permit (c.g., Enter "Cant," for conumrous
<br />moritoring, ": -' far on; day per Meek, "~ ,0" :nr one dry per month, ' /•"90" for one day per quarter, etc.)
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<br />('-~. Enter "~,u•tplc ;,~p:" bo!h as "San;rlr -tt:.,.c..reu,enP' (actual sample (yfir used during monitoring period) and as
<br />I~~'Permit ,4~•ourremcnr," (e.g., Fnter "li•~,h" for individual sample, ?4HC' Cor 24-hour emmposne, "N/A" for
<br />r~ continuous monitoring, etc.l
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<br />:.When violatioes ;,t permit regmr_mc,nts ,:•e revered, attach a brief explar:alion to describe cause and corrective
<br />actions taken, and referent: each violation by da!c.
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<br />. V"no discliarg~" occurs during monitoring p^rioc'. enter "No Discharge" across form in place of data entry.
<br />Enter ",Name/!•itle oJPnncipaf Exerrtive O,~cer' Kith "Signnlure ojPrmcipal Executive Officer ojAurhorized
<br />Agent," "Telephone Number," and "llate" ai bottom uflo~n.
<br />Mail signed Rer~•a to OtTce(s) by date(s) specified in peruut. Retain copy for your records.
<br />Marc detailed insVuction: for use of this Discharge Afonrroring ltrr,ort (DAfR) form may be obtained from O6ce(s)
<br />specified in permit.
<br />Legal li otice
<br />report is reyuireJ h~ law (33 U.S.C. 131: ; 40 C f' R. 125.27). Failure to revert or failure to report truthfully can
<br />m civil pzmltie> not tc ~ :~ xJ S 10,(100 per day ~I' ~. ~.aatiom; or in criminal penalties not to exceed 225,000 per day
<br />rlittion, of by imprisomnznt for not mire Lhar r ~ year, nr by both.
<br />3330-1 (Eev. OR-951
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