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Paperwork Reduction Act Notice
<br />~ Public reporting burden for [his wllectic•n of information is estimated to vary from a range of (0 hours as an
<br />i average per response for some minor facilities, to 1 l0 hours as m average per response for some major facilities,
<br />with a weighted average for major and minor facilities of 18 hours per response, including time for reviewing
<br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
<br />reviewing the collection of information. Send comments regarding the burc!en estimate or any other aspect of
<br />~ this collection of information, mcluding 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, Offi„e of Management and Budget, Washington, DC 20503.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed at entry of that information
<br />already preprinted.
<br />2. Enter 'Permittee Namei3fuiling Adr+ress (and facility name/loralion, if different)," "Permir A'wnber," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates begitming and ending 'iLlariroring Period" coeered by form where indicated.
<br />4. Enter each "Parmneter" az specified in monitoring requir~men[s of permit.
<br />5. Enter "Sample Alro.~uremeni" data for :ach parameter under "Quantity" and "Quclity" in units specified in permit.
<br />"Average" is nonnaJl} anth.netic avenge (geometric average for bacterial ~aramclers) of all sample measurements
<br />far each paramc!er .obtained during "t./onCuring Period'; ",tloxirnum" and ".Ilu;nnum" are nornutlly extreme high
<br />anG row measurements obtaieed during ",1lonuoring Peru+d" (Note to municipals v••ith s~ondary treatment
<br />regmremenC Enter 30-d .} „scrage of sample measurctr.cnLS under "Avert.;e," and enter maximum 7~ay a~•zrage
<br />of sample measurements outainal during monitonng period under "Maximu,n.
<br />6. Enter "Permir Requi~rme+rt" for east pmamcter under "Quantity" and "Qua'ity" az specified in permit.
<br />7. Under "Vo Er" uncr rumba of sample measunnents during monitorinf; period Hutt exceed ma~cimum !and/or
<br />minimum or 7Kiay average as a,~propri,tte) pemtii requirement for each parumcter. Tf none, enter "o".
<br />8. Enter "F'regvency nj -lnalysir" Eoth rs "S'mnple Measurment" (actual frequent.} of sampling and analysis used
<br />during monitonng periods and as "Permit Requiremem" specified in pcrn~it. (e g., Enter "Cant," for continuous
<br />monitoring, "1 r7" fo- one day per week ":. 30" for one day per month, "1/9G" for one day per quarter, etc.)
<br />9. Enter "Smnple Tppe" both az "Sample ,ifea.cunutent" (actual sample type used during monitoring period) and az
<br />"Permir Requirement," (e.g., Enter ":,tab" for individual sample, "14ilC' Cor 24-hour rnmposite, "NiA" for
<br />rnntinuous monitoring, etc.)
<br />" -' 10. Where violations of permit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and reference each violas on by date.
<br />11. if "no discharge" occurs during monitoring period, enter' No Discharge" across form in place of data entry.
<br />12. Enter "Nnme/fitle of Principal Execu~ive Officer" with "Signa(ure ojPnncipnl Executive Oi7icer ojAuthorized
<br />Agent," "Telephone Number," and "Date" at bottom of form.
<br />l3. Mail signed Report to Office(s)'by date(s) specified in permit. Retain copy fur your records.
<br />l4. More detailed instructions for use of this Discharge Afomroring Report (DA/R) form may be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />'Ibis report is rtquired by I.aw (33 U.:i.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 iby imprisonment for root more than one year, or by both.
<br />EPA Form 3320-1 (Rev. 08-9~
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