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1'aperworK Reduction Act Notice
<br />Public reporting burden for this collection of information is estimated to vary from a sage of 10 hours as an
<br />average per response for t70fne minor facilities, to 110 hours as an average par response for some major facilities,
<br />with a weighted average for major and minor fac8itin of 16 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. Seed comments re~a-ding 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. Eov.ronmental Protection Agency, 401 ivi Street, SW Washington, DC 20460; and to the
<br />Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 2051}3.
<br />General Instructions
<br />1. If form has been partially completed by preprinting, disregard instructions directed et entry of that informrtion
<br />already preprinted.
<br />2. Enter "Permittee Name/Afailing Address (and facility name location, if different)," "Permit Number," and
<br />"Discharge Number" where indicated. (A separate form is required for each discharge.)
<br />3. Enter dates beginning and ending 'Monitoring Period" covered by form where indicated.
<br />4. Enter each "Parameter" ;s specified in monitoring requirements of permit.
<br />5. Enter':Samp/e Aleasurement" data for each parameter under "Quantity" and "Quality" in units specified in permit.
<br />"Average" is normally aritlunetic average (geometric avemge for bacterial parameters) of all sample measurements
<br />for each parameter obtai red during "dlonitvring Period"; "Maximum" and "Minimum" are normally exVeme high
<br />and low measurements obtained during "Momtoring Period." (Note to municioas with secondary treaunen[
<br />requirement: Enter 30-day zvemge of sample n:casurements under "Average," and enter traximum 7~ay average
<br />of sampie mcasure,nenis :,brained during monitoring period under "Ma.r,n,urn.'J
<br />6. Enter "Fermi! RequiremenC' for each parameter under "Quantity" and "Ovality" as speed in permit.
<br />7. Undcr ".No Es" toter m mbar of sample measurments during monitoring period that exceed maximum (and/or
<br />nilaimum or 7~ay avcral,t as appropriate) penni[ requirement for each parameter ff none, enter "0".
<br />8. Enter "Frequencv ojAn.~lysis" both as "Snrnple .4./easurmenr" (actual frequency of sampling and analysis used
<br />during ctoni[oring period) and as "Fermi! Requirement" specified in permit (e. g., Enter "Cone," for continuous
<br />monitoring, "l/T' for one day per week, "1 i30" for one day per monOt, "//90" for one day per quarter. etc.)
<br />9. Enter ".Sample T}y~° both as "Sample Aleasurement" (actual sample type used during monitoring period) and as
<br />"Permit Requirement," (e.g., Enter "Grab" for individual sample, "2JHC" for 24-hour composite, ",~~A" for
<br />continuous monitoring, etc.)
<br />]0. Where violations of perrttit requirements are reported, attach a brief explanation to describe cause and corrective
<br />actions taken, and refe,cnce each vdolation by dale.
<br />11. if "no discharge" occurs during monitoring period, enter "h'o Discharge" across form in place of data entry.
<br />12. Enter "A'ameiTitle ojPrincipai Erendive O~cer" with "Signature ojPrinc,pni Fsecutive OJTcer ojAulhorized
<br />Agent," ".Telephone Number," and "Date" at bottom of form.
<br />13. Mail signed Report to Office(s) b}' date(s) specified in permit. Retain copy for your records.
<br />14. More detailed instructions for use of this Discharge,Llonitoring Report (DA1R) form ma}• be obtained from Office(s)
<br />specified in permit.
<br />Legal Notice
<br />This report is required by law (33 U.S.C. 1318; 40 C.l'.R. 125.27). Failure to rtport or failure to report truthfully can
<br />result in civi p~,aal[ies oct w ex;etd SI0,000 per day of violation; or in criminal penalties ao! to exceed 525,000 pzr day
<br />et violation, or by imp,iseamen~ for cot mort that. one year, or by both.
<br />EPA Form 3320-1 (Rev. OS-95)
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